Basic Information
| Provider Information | |||||||||
| NPI: | 1851826291 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COMPLETE CARE AT PASSAIC LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | COMPLETE CARE AT FAIR LAWN EDGE LLC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 TRUMAN AVENUE | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087015661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7329663091 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 77 E 43RD ST | ||||||||
| Address2: | |||||||||
| City: | PATERSON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 075141116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737546700 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2017 | ||||||||
| LastUpdateDate: | 12/16/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | STEIN | ||||||||
| AuthorizedOfficialFirstName: | SHALOM | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 7329663091 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.