Healthcare Provider Details

I. General information

NPI: 1790820157
Provider Name (Legal Business Name): DELLRIDGE HEALTH AND REHABILITATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 N FARVIEW AVE
PARAMUS NJ
07652-4130
US

IV. Provider business mailing address

532 N FARVIEW AVE
PARAMUS NJ
07652-4130
US

V. Phone/Fax

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

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: MS. ANNE MARIE GAUNTLETT
Title or Position: ADMINISTRATOR
Credential: LNHA
Phone: 201-265-5600