Provider Demographics
NPI:1427507235
Name:SELAH ADULT CARE CORPORATION
Entity type:Organization
Organization Name:SELAH ADULT CARE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRANQUILLI
Authorized Official - Suffix:
Authorized Official - Credentials:CDP, CDCM, CADDCT
Authorized Official - Phone:908-797-7193
Mailing Address - Street 1:133 FOURTH STREET
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:NJ
Mailing Address - Zip Code:07823
Mailing Address - Country:US
Mailing Address - Phone:908-797-7193
Mailing Address - Fax:877-627-7787
Practice Address - Street 1:133 FOURTH STREET
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:NJ
Practice Address - Zip Code:07823
Practice Address - Country:US
Practice Address - Phone:908-797-7193
Practice Address - Fax:877-627-7787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD35026311500000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD35026OtherFACILITY LICENSE NUMBER