Healthcare Provider Details

I. General information

NPI: 1033194626
Provider Name (Legal Business Name): CLOVER REST HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 WASHINGTON ST
COLUMBIA NJ
07832-2324
US

IV. Provider business mailing address

PO BOX 223 28 WASHINGTON ST.
COLUMBIA NJ
07832-0223
US

V. Phone/Fax

Practice location:
  • Phone: 908-496-4307
  • Fax: 908-496-9420
Mailing address:
  • Phone: 908-496-4307
  • Fax: 908-496-9420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number62104
License Number StateNJ

VIII. Authorized Official

Name: MR. ARTHUR W ROBBINS
Title or Position: CONTROLLER
Credential:
Phone: 908-496-4307