Healthcare Provider Details

I. General information

NPI: 1669423000
Provider Name (Legal Business Name): SENIORCARE REHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 11/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 E MADISON AVE
CLIFTON NJ
07011-2323
US

IV. Provider business mailing address

109 BIRCH ST
BLOOMFIELD NJ
07003-4017
US

V. Phone/Fax

Practice location:
  • Phone: 973-931-1717
  • Fax: 973-582-9288
Mailing address:
  • Phone: 973-931-1717
  • Fax: 973-582-9288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: GARRY SANCHEZ
Title or Position: PARTNER/OWNER
Credential:
Phone: 973-931-1717