Healthcare Provider Details

I. General information

NPI: 1013003854
Provider Name (Legal Business Name): DELLRIDGE HEALTH AND REHABILITATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 N FARVIEW AVE
PARAMUS NJ
07652-4130
US

IV. Provider business mailing address

532 FARVIEW AVENUE
PARAMUS NJ
07652
US

V. Phone/Fax

Practice location:
  • Phone: 201-265-5600
  • Fax: 201-261-3164
Mailing address:
  • Phone: 201-265-5600
  • Fax: 265-261-3164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number060207
License Number StateNJ

VII. Legacy identifiers

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

# 1
Identifier4464109
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: MR. EDWARD FRIEDMAN
Title or Position: E VP
Credential:
Phone: 201-265-5600