Seacrest Village, Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

NJ61522 Issued in NJ

Legal business name

SEACREST VILLAGE, INC

Practice address

1001 Center St
Little Egg Harbor TWP, NJ 08087-1347

Phone

(609) 296-9292

Fax

(609) 296-0508

NPI assigned

Sep 30, 2005

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Brian T. Holloway

Title

President

Phone

(609) 296-9292

Specialties & licenses 1

Addresses

Other identifiers 3

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

{
    "created_epoch": "1128038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1144217662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 CENTER ST",
            "address_2": "PO BOX 1480",
            "city": "LITTLE EGG HARBOR TWP",
            "state": "NJ",
            "postal_code": "080871347",
            "telephone_number": "609-296-9292",
            "fax_number": "609-296-0508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 CENTER ST",
            "city": "LITTLE EGG HARBOR TWP",
            "state": "NJ",
            "postal_code": "080871347",
            "telephone_number": "609-296-9292",
            "fax_number": "609-296-0508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEACREST VILLAGE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HOLLOWAY",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "609-296-9292",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NJ",
            "license": "NJ61522",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4494717",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4494709",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0077801",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kimberly Sand, MPT
• Seacrest Assisted Living LLC (The Terraces at Seacrest Village)
• Seacrest Operator, LLC (Seacrest Rehabilitation and Healthcare Center)
• Seacrest Village
• Seacrest Village Adult Day Care
• Leigh A Seeley
• Yvette Sari Shaber, RPH
• Shirley M Shaffery, BSN
• Shore to Advance Therapy Services
• Stacey Smith

• Skilled Nursing Facility in Little Egg Harbor TWP, NJ
• Providers in Little Egg Harbor TWP, NJ by specialty
• Skilled Nursing 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.