2ND Home Elizabeth LLC

Primary specialty

Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X

License

908111 Issued in NJ

Legal business name

2ND HOME ELIZABETH LLC

Practice address

432 N Broad St
Elizabeth, NJ 07208-3365

Phone

(908) 436-0018

Fax

(973) 278-4773

NPI assigned

Feb 16, 2007

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

David Myers, M.D.

Title

Medical Director

Phone

(973) 278-7065

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1171584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1336283027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 HAMILTON PLZ",
            "address_2": "3RD FLOOR",
            "city": "PATERSON",
            "state": "NJ",
            "postal_code": "075052109",
            "telephone_number": "973-278-7065",
            "fax_number": "973-278-4773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "432 N BROAD ST",
            "city": "ELIZABETH",
            "state": "NJ",
            "postal_code": "072083365",
            "telephone_number": "908-436-0018",
            "fax_number": "973-278-4773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "2ND HOME ELIZABETH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MYERS",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "973-278-7065",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "NJ",
            "license": "908111",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7667027",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• 2ND Home Elizabeth Operations, LLC
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• 360 New Jersey Medical Group Professional Corporation
• A & J Union Home Care
• A Rest Assured Home Health Care Agency LLC

• Nursing Facility/Intermediate Care Facility in Elizabeth, NJ
• Providers in Elizabeth, NJ by specialty
• Nursing Facility/Intermediate Care 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.