Provider Demographics
NPI:1467687343
Name:MONASTERY RESIDENNCE
Entity type:Organization
Organization Name:MONASTERY RESIDENNCE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:WIMBERLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-424-3106
Mailing Address - Street 1:201 CROSSWICKS ST
Mailing Address - Street 2:
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505-1740
Mailing Address - Country:US
Mailing Address - Phone:609-424-3106
Mailing Address - Fax:609-298-5527
Practice Address - Street 1:201 CROSSWICKS ST
Practice Address - Street 2:
Practice Address - City:BORDENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08505-1740
Practice Address - Country:US
Practice Address - Phone:609-424-3106
Practice Address - Fax:609-298-5527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-21
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ10A101310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility