Second Home Perth Amboy LLC

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

Z0SFLR Issued in NJ

Legal business name

SECOND HOME PERTH AMBOY LLC

Practice address

420 Fayette St
Perth Amboy, NJ 08861-3835

Phone

(732) 826-8012

Fax

(732) 826-1961

NPI assigned

May 10, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Debroah Minassian

Title

President

Phone

(973) 279-2323

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

2ND Home Perth Amboy LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• 2ND Home Perth Amboy LLC

  • Nursing Facility/Intermediate Care Facility
  • Perth Amboy, NJ
  • NPI 1548304223
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1063627545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 HAMILTON PLZ",
            "city": "PATERSON",
            "state": "NJ",
            "postal_code": "075052109",
            "telephone_number": "973-279-2323",
            "fax_number": "973-278-6284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 FAYETTE ST",
            "city": "PERTH AMBOY",
            "state": "NJ",
            "postal_code": "088613835",
            "telephone_number": "732-826-8012",
            "fax_number": "732-826-1961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SECOND HOME PERTH AMBOY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MINASSIAN",
        "authorized_official_first_name": "DEBROAH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "973-279-2323",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NJ",
            "license": "Z0SFLR",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7667043",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ofelia Lacson Sarroca, M.D.
• Lorraine Lillian Saunders, PA-C
• Saving Grace Counseling Services
• Jeff Jay Schaeffer, O.D.
• Esther Schlesinger, MD
• Roseline K. Sele-Williams, APN
• Justin Serrano
• Aarti Shah, RPH
• Gopika Haren Shah, MA-CCC-SLP
• Iram Fatima Shah, P.T

• Adult Care Home Facility in Perth Amboy, NJ
• Providers in Perth Amboy, NJ by specialty
• Adult Care Home Facility in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.