Healthcare Provider Details

I. General information

NPI: 1912953886
Provider Name (Legal Business Name): MERIDIAN NURSING AND REHABILITATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 05/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 MERIDIAN TRAIL
WALL NJ
07719-9671
US

IV. Provider business mailing address

1725 MERIDIAN TRAIL
WALL NJ
07719-9671
US

V. Phone/Fax

Practice location:
  • Phone: 732-312-1800
  • Fax: 732-312-1801
Mailing address:
  • Phone: 732-312-1800
  • Fax: 732-312-1801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. PHYLLIS A DEYO
Title or Position: DIRECTOR LTC ACCOUNTS
Credential:
Phone: 732-312-1670