Healthcare Provider Details

I. General information

NPI: 1104965615
Provider Name (Legal Business Name): JEWISH HOME AT ROCKLEIGH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 LINK DR
ROCKLEIGH NJ
07647-2504
US

IV. Provider business mailing address

10 LINK DR
ROCKLEIGH NJ
07647-2504
US

V. Phone/Fax

Practice location:
  • Phone: 201-784-1414
  • Fax: 201-750-4266
Mailing address:
  • Phone: 201-784-1414
  • Fax: 201-750-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberJZ24OP
License Number StateNJ

VIII. Authorized Official

Name: MRS. SUNNI HERMAN
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 201-750-4236