Provider Demographics
NPI:1285898924
Name:ROSEVILLE HEALTH CARE LLC
Entity type:Organization
Organization Name:ROSEVILLE HEALTH CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:WILLIAMS
Authorized Official - Last Name:CUDJOE
Authorized Official - Suffix:
Authorized Official - Credentials:CALA
Authorized Official - Phone:973-481-2200
Mailing Address - Street 1:516 COUNTY ROAD 513
Mailing Address - Street 2:
Mailing Address - City:PITTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08867-5031
Mailing Address - Country:US
Mailing Address - Phone:973-481-2200
Mailing Address - Fax:973-481-3200
Practice Address - Street 1:285 ROSEVILLE AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07107-1703
Practice Address - Country:US
Practice Address - Phone:973-481-2200
Practice Address - Fax:973-481-3200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-11
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility