Organization
VAN DYK'S SENIOR RESIDENCE OF HAWTHORNE, LLC
Active
Other names
Van Dyk's at Park Place
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
644 GOFFLE RD, HAWTHORNE, NJ 07506-3452
(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
8XD1WY
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8712301
—
NJ
Enumeration date
03/13/2007
Last updated
08/22/2020
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