Healthcare Provider Details

I. General information

NPI: 1013903103
Provider Name (Legal Business Name): JERSEY SHORE CONVALESCENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 06/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 SIXTH AVE
NEPTUNE CITY NJ
07753-6124
US

IV. Provider business mailing address

2050 6TH AVE
NEPTUNE CITY NJ
07753-6124
US

V. Phone/Fax

Practice location:
  • Phone: 732-774-8300
  • Fax: 732-774-0908
Mailing address:
  • Phone: 732-774-8300
  • Fax: 732-774-0908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number061317
License Number StateNJ

VIII. Authorized Official

Name: MARY LOU BROWNING
Title or Position: ADMINISTRATOR
Credential: LNHA
Phone: 732-774-8300