MEDICARE: JERSEY SHORE CONVALESCENT CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	061317	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013903103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JERSEY SHORE CONVALESCENT CENTER

Provider Business Mailing Address
First Line	:	2050 6TH AVE
Second Line	:
City	:	NEPTUNE CITY
State	:	NJ
Zip	:	07753-6124
Country	:	US
Telephone Number	:	732-774-8300
Fax Number	:	732-774-0908

Provider Business Practice Location Address
First Line	:	2050 SIXTH AVE
Second Line	:
City	:	NEPTUNE CITY
State	:	NJ
Zip	:	07753-6124
Country	:	US
Telephone Number	:	732-774-8300
Fax Number	:	732-774-0908

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MARY LOU BROWNING
Credential	:	LNHA
Telephone Number	:	732-774-8300

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	06/03/2010

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