Healthcare Provider Details

I. General information

NPI: 1235118514
Provider Name (Legal Business Name): CHABRUSA CONVALESCENT CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 CALDWELL AVE
SADDLE BROOK NJ
07663-6021
US

IV. Provider business mailing address

15 CALDWELL AVE
SADDLE BROOK NJ
07663-6021
US

V. Phone/Fax

Practice location:
  • Phone: 201-843-7333
  • Fax: 201-843-6448
Mailing address:
  • Phone: 201-843-7333
  • Fax: 201-843-6448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number60216
License Number StateNJ

VIII. Authorized Official

Name: MRS. SANDRA A OLSHALSKY
Title or Position: ADMINISTRATOR
Credential:
Phone: 201-843-7333