Provider Demographics
NPI:1992085377
Name:BRICK SENIOR CARE, LLC
Entity type:Organization
Organization Name:BRICK SENIOR CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-889-4200
Mailing Address - Street 1:458 JACK MARTIN BLVD
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-7739
Mailing Address - Country:US
Mailing Address - Phone:732-206-9800
Mailing Address - Fax:732-206-9801
Practice Address - Street 1:458 JACK MARTIN BLVD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-7739
Practice Address - Country:US
Practice Address - Phone:732-206-9800
Practice Address - Fax:732-206-9801
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CMG CHELSEA SENIOR CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ65A007310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility