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Organization
COUNTY OF GLOUCESTER
Active
Organization
COUNTY OF GLOUCESTER
Active
Other names
Shady Lane Nursing Home
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PETE SCAFFIDI (ACCOUNTANT)
(856) 423-5318
Entity
Organization
Contact information
Practice address
256 COUNTY HOUSE RD, CLARKSBORO, NJ 08020-1395
(856) 423-5318
(856) 423-3634
Mailing address
254 COUNTY HOUSE RD, CLARKSBORO, NJ 08020-1395
(856) 423-5318
(856) 423-3634
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
060805
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4478703
—
NJ
Enumeration date
03/16/2007
Last updated
06/24/2008
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