Center State Health Group Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

061503 Issued in NJ

Legal business name

CENTER STATE HEALTH GROUP INC.

Practice address

16 Whitesville Rd
Toms River, NJ 08753-4107

Phone

(732) 736-5106

Fax

(732) 286-3165

NPI assigned

Jul 10, 2006

Organization subpart

No

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

Authorized official

Name

David Sweeney

Title

Cfo

Phone

(908) 851-8355

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Country Manor Doing business as

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200268800000",
    "number": "1396779245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "54 NEWCOMBE ST",
            "city": "BELLEVILLE",
            "state": "NJ",
            "postal_code": "071091236",
            "telephone_number": "973-450-2908",
            "fax_number": "973-844-4705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 WHITESVILLE RD",
            "city": "TOMS RIVER",
            "state": "NJ",
            "postal_code": "087534107",
            "telephone_number": "732-736-5106",
            "fax_number": "732-286-3165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER STATE HEALTH GROUP INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-10",
        "last_updated": "2008-01-14",
        "status": "A",
        "authorized_official_last_name": "SWEENEY",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "908-851-8355"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NJ",
            "license": "061503",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4494407",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4494504",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Country Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Joseph J Caucino Jr., ATC
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• Skilled Nursing Facility in Toms River, NJ
• Providers in Toms River, 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 Jan 14, 2008; 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.