Basic Information
| Provider Information | |||||||||
| NPI: | 1174918353 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREENFIELD OF GLASSBORO LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | GREENFIELD SENIOR LIVING AT CROSS KEYS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6312 SEVEN CORNERS CTR # 161 | ||||||||
| Address2: | |||||||||
| City: | FALLS CHURCH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220442409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7032375606 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3152 GLASSBORO CROSS KEYS RD | ||||||||
| Address2: | |||||||||
| City: | GLASSBORO | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080282723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563072100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2015 | ||||||||
| LastUpdateDate: | 04/03/2015 | ||||||||
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| AuthorizedOfficialLastName: | PEPONIS | ||||||||
| AuthorizedOfficialFirstName: | MATHEW | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7039629125 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | NJ | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.