Provider Demographics
NPI:1174925572
Name:SHORROCK GARDENS CARE CENTER, INC.
Entity type:Organization
Organization Name:SHORROCK GARDENS CARE CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-244-1400
Mailing Address - Street 1:1730 RTE 37 W
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08757-2345
Mailing Address - Country:US
Mailing Address - Phone:732-244-1400
Mailing Address - Fax:244-732-4704
Practice Address - Street 1:75 OLD TOMS RIVER RD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-7800
Practice Address - Country:US
Practice Address - Phone:732-451-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHORROCK GARDENS CARE CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ65A004310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7902417Medicaid