Provider Demographics
NPI:1487366142
Name:SHP VI CENTERTON MOUNT LAUREL LLC
Entity type:Organization
Organization Name:SHP VI CENTERTON MOUNT LAUREL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:
Authorized Official - Last Name:GABAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-704-3789
Mailing Address - Street 1:7 GIRALDA FARMS
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940-1051
Mailing Address - Country:US
Mailing Address - Phone:404-704-3789
Mailing Address - Fax:
Practice Address - Street 1:785 CENTERTON RD
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-1607
Practice Address - Country:US
Practice Address - Phone:856-367-3006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility