Healthcare Provider Details

I. General information

NPI: 1447369285
Provider Name (Legal Business Name): COUNTY MANOR REHABILITATION & HEALTH CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 01/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 COUNTY RD
TENAFLY NJ
07670-1815
US

IV. Provider business mailing address

133 COUNTY RD
TENAFLY NJ
07670-1815
US

V. Phone/Fax

Practice location:
  • Phone: 201-567-7800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number060206
License Number StateNJ

VIII. Authorized Official

Name: AVI MAIEROVITS
Title or Position: CONTROLLER
Credential:
Phone: 732-994-4324