Provider Demographics
| NPI: | 1285465435 |
|---|---|
| Name: | GRANDULAR SENIOR LIVING |
| Entity type: | Organization |
| Organization Name: | GRANDULAR SENIOR LIVING |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CEO |
| Authorized Official - Prefix: | MRS |
| Authorized Official - First Name: | DEBORAH |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | DICKERSON |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 609-669-0097 |
| Mailing Address - Street 1: | 542 BERLIN CROSS KEYS RD. STE.3-270 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | SICKLERVILLE |
| Mailing Address - State: | NJ |
| Mailing Address - Zip Code: | 08081 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 609-669-0097 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 542 BERLIN CROSS KEYS RD. STE.3-270 |
| Practice Address - Street 2: | |
| Practice Address - City: | SICKLERVILLE |
| Practice Address - State: | NJ |
| Practice Address - Zip Code: | 08081 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 609-553-3180 |
| Practice Address - Fax: | 856-875-9608 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2024-08-09 |
| Last Update Date: | 2024-08-11 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 251S00000X | Agencies | Community/Behavioral Health | ||
| No | 252Y00000X | Agencies | Early Intervention Provider Agency | ||
| No | 261QD1600X | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities | |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | |
| No | 261QU0200X | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | |
| No | 273R00000X | Hospital Units | Psychiatric Unit | ||
| No | 276400000X | Hospital Units | Rehabilitation, Substance Use Disorder Unit | ||
| No | 281PC2000X | Hospitals | Chronic Disease Hospital | Children | |
| No | 283Q00000X | Hospitals | Psychiatric Hospital | ||
| No | 283XC2000X | Hospitals | Rehabilitation Hospital | Children | |
| No | 315D00000X | Nursing & Custodial Care Facilities | Hospice, Inpatient | ||
| No | 315P00000X | Nursing & Custodial Care Facilities | Intermediate Care Facility, Intellectual Disabilities | ||
| No | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness |
