Healthcare Provider Details

I. General information

NPI: 1851492789
Provider Name (Legal Business Name): LIBERTY NURSING HOME OF JERSEY CITY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 01/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 MONTGOMERY ST
JERSEY CITY NJ
07302-3130
US

IV. Provider business mailing address

620 MONTGOMERY ST
JERSEY CITY NJ
07302-3130
US

V. Phone/Fax

Practice location:
  • Phone: 201-435-0033
  • Fax: 201-435-0655
Mailing address:
  • Phone: 201-435-0033
  • Fax: 201-435-0655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number060903
License Number StateNJ

VIII. Authorized Official

Name: MR. ISRAEL BRAUNSTEIN
Title or Position: CFO
Credential:
Phone: 201-435-0033