Organization
VAN DYK AT BALD EAGLE COMMONS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES H SHOTMEYER (CHIEF FINANCIAL OFFICER)
(201) 689-7979
Entity
Organization
Contact information
Practice address
197 CAHILL CROSS RD, WEST MILFORD, NJ 07480-1947
(201) 689-7979
(973) 304-2046
Mailing address
644 GOFFLE RD, HAWTHORNE, NJ 07506-3452
(201) 689-7979
(973) 304-2046
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
70A000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8379009
—
NJ
Enumeration date
03/13/2007
Last updated
08/22/2020
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