Healthcare Provider Details

I. General information

NPI: 1710986823
Provider Name (Legal Business Name): GREENWOOD HOUSE, HOME FOR THE JEWISH AGED INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 WALTER ST
EWING NJ
08628-3016
US

IV. Provider business mailing address

53 WALTER ST
EWING NJ
08628-3016
US

V. Phone/Fax

Practice location:
  • Phone: 609-883-5391
  • Fax: 609-530-1635
Mailing address:
  • Phone: 609-883-5391
  • Fax: 609-530-1635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number031101
License Number StateNJ

VIII. Authorized Official

Name: MR. RICHARD S GOLDSTEIN
Title or Position: EXECUTIVE DIRECTOR
Credential: LNHA
Phone: 609-883-5391