Healthcare Provider Details

I. General information

NPI: 1962695478
Provider Name (Legal Business Name): JEWISH HOME ASSISTED LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 WESTWOOD AVE
RIVERVALE NJ
07675-6335
US

IV. Provider business mailing address

685 WESTWOOD AVE
RIVERVALE 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 TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number02A00
License Number StateNJ

VIII. Authorized Official

Name: MRS. BRANDY STEFANCO
Title or Position: CFO
Credential:
Phone: 201-750-4232