1235118514 NPI number — CHABRUSA CONVALESCENT CENTER, INC.

Table of content: (NPI 1235118514)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235118514 NPI number — CHABRUSA CONVALESCENT CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHABRUSA CONVALESCENT CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SADDLE BROOK CONVALESCENT HOME
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235118514
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 CALDWELL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SADDLE BROOK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07663-6021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-843-7333
Provider Business Mailing Address Fax Number:
201-843-6448

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 CALDWELL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SADDLE BROOK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07663-6021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-843-7333
Provider Business Practice Location Address Fax Number:
201-843-6448
Provider Enumeration Date:
01/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
OLSHALSKY
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
201-843-7333

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  60216 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 315385 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICARE ID-TYPE UNSPECIFIED".
  • Identifier: 4463803 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".