# SECOND HOME PERTH AMBOY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063627545
- **Authorized official:** MRS. DEBROAH MINASSIAN (PRESIDENT)
- **Authorized official phone:** (973) 279-2323

## Contact information

- **Practice address:** 420 FAYETTE ST, PERTH AMBOY, NJ 08861-3835
- **Practice address phone:** (732) 826-8012
- **Practice address fax:** (732) 826-1961
- **Mailing address:** 100 HAMILTON PLZ, PATERSON, NJ 07505-2109
- **Mailing address phone:** (973) 279-2323
- **Mailing address fax:** (973) 278-6284

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | Z0SFLR | NJ | Yes |

## Other

- **Enumeration date:** 05/10/2007
- **Last updated:** 08/22/2020