PROVIDER CONTRACT INFORMATION
For Consideration
Fax To: 732.840.1834
Attention: Denise Van Tassell
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PROVIDER CONTRACT INFORMATION For Consideration Fax To: 732.840.1834 Attention: Denise Van Tassell |
General Information: Care First For Seniors, LLC, is a private Senior Care Placement Firm whose mission is to provide appropriate and expedient placement of those in need of an Extended Care Facility. This can be an Assisted Living, Skilled Nursing / Rehabilitation Facility, Independent Living or Continuing Care Retirement Community. We also match clients for Adult Day Care. Our decisions on where to assist placing clients is based on the appropriateness of the contracted facility and on the physical and psycho-social needs of our clients. It is our business to know which facilities provide the best care, have the most positive feedback as well as other factors such as recent regulatory surveys, accreditation or other official designations or specialty programs.
To be considered, the provider must complete the below information and fax it to the above number. One of our representatives will contact you regarding a facility tour and a personal meeting with the ownership and administration of the facility. No contracts will be entered into without the former at a minimum. Letters of recommendation from recent clients in your facility are strongly recommended to have for our review, and said letters must be verifiable. Care First For Seniors, LLC complies with all Medicare and Medicaid laws and regulations. We will not accept remuneration for any client placed whose stay is financed by either Medicare or Medicaid under any circumstances. Fees to the provider will apply for all other referrals as outlined in your contract.
Parent Company Name:______________________________________________________________
Facility Name: ___________________________________________ Address: _____________________________________________________
Facility Name: ___________________________________________ Address: _____________________________________________________
Facility Name: ___________________________________________ Address: _____________________________________________________
Facility Name: ___________________________________________ Address: _____________________________________________________
Facility Name: ___________________________________________ Address: _____________________________________________________
Facility Name: ___________________________________________ Address: _____________________________________________________
Facility Name: ___________________________________________ Address: _____________________________________________________
Facility Name: ___________________________________________ Address: _____________________________________________________
Contact Person: ___________________________________________________________
Contact Phone #:______________________________________ Mobile#:____________________________________
Contact Fax #:________________________________________ Website: http://____________________________________________________
E-Mail: ______________________________________________________________