Healthcare Provider Details

I. General information

NPI: 1073742318
Provider Name (Legal Business Name): GREENBROOK MANOR CARE & REHABILITATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2009
Last Update Date: 07/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 ROCK AVE
GREEN BROOK NJ
08812-2616
US

IV. Provider business mailing address

100 MCCLELLEN ST
NORWOOD NJ
07648-1555
US

V. Phone/Fax

Practice location:
  • Phone: 201-767-0100
  • Fax:
Mailing address:
  • Phone: 201-767-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number061805
License Number StateNJ

VIII. Authorized Official

Name: MR. EDWARD S NEUMANN
Title or Position: CFO
Credential:
Phone: 201-767-0100