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NPI Code Detail

MEDICARE: EAGLE ROCK CONVALESCENT CENTER, INC.

MEDICARE: EAGLE ROCK CONVALESCENT CENTER, INC.
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
1314000000XSkilled Nursing Facility060734NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
107750OTHERNJNJ
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154328714
Entity Type Code : Organization
Provider Name (Legal Business Name) : EAGLE ROCK CONVALESCENT CENTER, INC.
Provider Business Mailing Address
First Line : 165 FAIRFIELD AVE
Second Line :
City : WEST CALDWELL
State : NJ
Zip : 07006-6414
Country : US
Telephone Number : 973-226-1100
Fax Number : 973-226-5993
Provider Business Practice Location Address
First Line : 165 FAIRFIELD AVE
Second Line :
City : WEST CALDWELL
State : NJ
Zip : 07006-6414
Country : US
Telephone Number : 973-226-1100
Fax Number : 973-226-5993
Authorized Official
Title or Position : PRESIDENT
Name : MR. RICHARD PINELES
Credential :
Telephone Number : 201-489-7400
Provider Enumeration Date : 06/28/2005
Last Update Date : 06/27/2008

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