Provider Demographics
NPI:1225859358
Name:DESSALINES PRIDE LLC
Entity type:Organization
Organization Name:DESSALINES PRIDE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMY
Authorized Official - Middle Name:
Authorized Official - Last Name:DESSALINES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-213-9337
Mailing Address - Street 1:1684 OLD TRENTON RD
Mailing Address - Street 2:
Mailing Address - City:WEST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08550-3205
Mailing Address - Country:US
Mailing Address - Phone:480-213-9337
Mailing Address - Fax:732-747-6001
Practice Address - Street 1:237 OAKLAND ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08618-3547
Practice Address - Country:US
Practice Address - Phone:480-213-9337
Practice Address - Fax:732-747-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility