Provider Demographics
NPI:1831232263
Name:MSH WEST ESSEX OPERATING LLC
Entity type:Organization
Organization Name:MSH WEST ESSEX OPERATING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMINITI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-228-7890
Mailing Address - Street 1:47 GREENBROOK RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07004-3890
Mailing Address - Country:US
Mailing Address - Phone:973-228-7890
Mailing Address - Fax:
Practice Address - Street 1:47 GREENBROOK RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-3890
Practice Address - Country:US
Practice Address - Phone:973-228-7890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ30A003310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8130906Medicaid