Healthcare Provider Details

I. General information

NPI: 1619444221
Provider Name (Legal Business Name): BERGEN POST ACUTE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2018
Last Update Date: 06/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 PROSPECT AVE
HACKENSACK NJ
07601
US

IV. Provider business mailing address

336 PROSPECT AVE
HACKENSACK NJ
07601-2506
US

V. Phone/Fax

Practice location:
  • Phone: 201-518-7800
  • Fax: 201-678-1801
Mailing address:
  • Phone: 201-518-7800
  • Fax: 201-678-1801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier315460
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerMEDICARE

VIII. Authorized Official

Name: MR. JOSEPH M LEMAIRE
Title or Position: PRESIDENT DIVERSIFIED VENTURES
Credential:
Phone: 732-751-7520