Healthcare Provider Details

I. General information

NPI: 1912120148
Provider Name (Legal Business Name): HARTWYCK WEST NURSING HOME, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 08/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 PARK AVE
PLAINFIELD NJ
07060-3227
US

IV. Provider business mailing address

98 JAMES ST 4TH FLOOR
EDISON NJ
08820-3902
US

V. Phone/Fax

Practice location:
  • Phone: 908-754-3100
  • Fax: 908-754-3418
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number062009
License Number StateNJ

VII. Legacy identifiers

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

# 1
Identifier2021Y
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer
# 2
Identifier20218
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer
# 3
Identifier4504305
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer
# 4
Identifier4505107
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: MR. THOMAS LANKEY
Title or Position: SR VP FOR LTC FACILITIES
Credential:
Phone: 732-321-7890