Provider Demographics
NPI:1902954761
Name:CAVALIER SENIOR CARE
Entity type:Organization
Organization Name:CAVALIER SENIOR CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:LIDING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-607-8307
Mailing Address - Street 1:2 HOLLYWOOD BLVD.
Mailing Address - Street 2:UNIT 5
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08731
Mailing Address - Country:US
Mailing Address - Phone:609-607-8300
Mailing Address - Fax:609-607-8307
Practice Address - Street 1:2 HOLLYWOOD BLVD.
Practice Address - Street 2:UNIT 5
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731
Practice Address - Country:US
Practice Address - Phone:609-607-8300
Practice Address - Fax:609-607-8307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0031100251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9001808Medicaid
NJ=========Medicare UPIN
NJ9001808Medicaid