Healthcare Provider Details

I. General information

NPI: 1548875172
Provider Name (Legal Business Name): JEWISH HOME ASSISTED LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 WESTWOOD AVE
RIVER VALE NJ
07675-6335
US

IV. Provider business mailing address

685 WESTWOOD AVE
RIVER VALE NJ
07675-6335
US

V. Phone/Fax

Practice location:
  • Phone: 201-666-2370
  • Fax: 201-664-7111
Mailing address:
  • Phone: 201-666-2370
  • Fax: 201-664-7111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: BRANDY STEFANCO
Title or Position: CFO
Credential:
Phone: 201-784-1414