2ND Home Passaic LLC

Primary specialty

Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X

License

708116 Issued in NJ

Legal business name

2ND HOME PASSAIC LLC

Practice address

63 Grove St
Passaic, NJ 07055-5001

Phone

(973) 278-7065

Fax

(973) 278-4773

NPI assigned

Feb 16, 2007

Organization subpart

No

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

Authorized official

Name

David M Myers, M.D.

Title

Medical Director

Phone

(973) 278-7065

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1171584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213315200000",
    "number": "1740324425",
    "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": "63 GROVE ST",
            "city": "PASSAIC",
            "state": "NJ",
            "postal_code": "070555001",
            "telephone_number": "973-278-7065",
            "fax_number": "973-278-4773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "2ND HOME PASSAIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-16",
        "last_updated": "2008-06-13",
        "status": "A",
        "authorized_official_last_name": "MYERS",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "M",
        "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": "708116",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0056421",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Providers in Passaic, 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 Jun 13, 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.