Healthcare Provider Details

I. General information

NPI: 1972139178
Provider Name (Legal Business Name): MAYWOOD SNF OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2020
Last Update Date: 03/19/2020
Certification Date: 03/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W MAGNOLIA AVE
MAYWOOD NJ
07607-1121
US

IV. Provider business mailing address

100 W MAGNOLIA AVE
MAYWOOD NJ
07607-1121
US

V. Phone/Fax

Practice location:
  • Phone: 201-843-8411
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SHLOMO GOLDBERGER
Title or Position: AUTHORIZED REP
Credential:
Phone: 347-524-0535