Provider Demographics
NPI:1447853965
Name:CANELAVILLE HEALTH CARE
Entity type:Organization
Organization Name:CANELAVILLE HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROLFFI
Authorized Official - Middle Name:
Authorized Official - Last Name:CANELA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:732-925-2407
Mailing Address - Street 1:243 BROADWAY UNIT 9188
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-7408
Mailing Address - Country:US
Mailing Address - Phone:732-925-2407
Mailing Address - Fax:
Practice Address - Street 1:611 HIDDEN VILLAGE DR
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-3367
Practice Address - Country:US
Practice Address - Phone:732-925-2407
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-18
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No385H00000XRespite Care FacilityRespite Care
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child