Provider Demographics
NPI:1174057764
Name:SHI-II HILLSBOROUGH, LLC
Entity type:Organization
Organization Name:SHI-II HILLSBOROUGH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO - CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:T
Authorized Official - Last Name:DIOGUARDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-496-1505
Mailing Address - Street 1:100 JERICHO QUADRANGLE
Mailing Address - Street 2:SUITE 142
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2708
Mailing Address - Country:US
Mailing Address - Phone:516-496-1505
Mailing Address - Fax:516-496-1509
Practice Address - Street 1:351 ROUTE 206
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-4651
Practice Address - Country:US
Practice Address - Phone:908-829-3157
Practice Address - Fax:908-829-3163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ311500000X, 310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)