Basic Information
| Provider Information | |||||||||
| NPI: | 1508134073 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AVANTE AT JERSEY CITY, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4000 HOLLYWOOD BLVD | ||||||||
| Address2: | SUITE 540 NORTH | ||||||||
| City: | HOLLYWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330216751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549877180 | ||||||||
| FaxNumber: | 9549895287 | ||||||||
| Practice Location | |||||||||
| Address1: | 620 MONTGOMERY ST | ||||||||
| Address2: | |||||||||
| City: | JERSEY CITY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 073023130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2014350033 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2011 | ||||||||
| LastUpdateDate: | 12/12/2011 | ||||||||
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| AuthorizedOfficialLastName: | LICHTMAN | ||||||||
| AuthorizedOfficialFirstName: | HARVEY | ||||||||
| AuthorizedOfficialMiddleName: | L. | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9549877180 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | NJ | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.