Provider Demographics
NPI:1063093706
Name:COMPLETE CARE AT SILVER LAKE LLC
Entity type:Organization
Organization Name:COMPLETE CARE AT SILVER LAKE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED SIGNER
Authorized Official - Prefix:
Authorized Official - First Name:SHALOM
Authorized Official - Middle Name:
Authorized Official - Last Name:STEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-313-0880
Mailing Address - Street 1:1080 SILVER LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-2410
Mailing Address - Country:US
Mailing Address - Phone:302-734-5990
Mailing Address - Fax:
Practice Address - Street 1:1080 SILVER LAKE BLVD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-2410
Practice Address - Country:US
Practice Address - Phone:302-734-5990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility