Van Dyk'S Senior Residence of Hawthorne, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

8XD1WY Issued in NJ

Legal business name

VAN DYK'S SENIOR RESIDENCE OF HAWTHORNE, LLC

Practice address

644 Goffle Rd
Hawthorne, NJ 07506-3452

Phone

(201) 689-7979

Fax

(973) 304-2046

NPI assigned

Mar 13, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Charles H Shotmeyer

Title

Chief Financial Officer

Phone

(201) 689-7979

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Van Dyk's at Park Place Other name

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1730212689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "644 GOFFLE RD",
            "city": "HAWTHORNE",
            "state": "NJ",
            "postal_code": "075063452",
            "telephone_number": "201-689-7979",
            "fax_number": "973-304-2046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "644 GOFFLE RD",
            "city": "HAWTHORNE",
            "state": "NJ",
            "postal_code": "075063452",
            "telephone_number": "201-689-7979",
            "fax_number": "973-304-2046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VAN DYK'S SENIOR RESIDENCE OF HAWTHORNE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SHOTMEYER",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "201-689-7979",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NJ",
            "license": "8XD1WY",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8712301",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Van Dyk's at Park Place",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Assisted Living Facility in Hawthorne, NJ
• Providers in Hawthorne, NJ by specialty
• Assisted Living 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.