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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