Healthcare Provider Details

I. General information

NPI: 1306842745
Provider Name (Legal Business Name): STRATFORD MANOR CARE & REHABILITATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 03/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

787 NORTHFIELD AVE
WEST ORANGE NJ
07052-1131
US

IV. Provider business mailing address

100 MCCLELLEN ST
NORWOOD NJ
07648-1555
US

V. Phone/Fax

Practice location:
  • Phone: 973-731-4500
  • Fax: 973-592-0226
Mailing address:
  • Phone: 201-767-0100
  • Fax: 201-881-1191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number060714
License Number StateNJ

VIII. Authorized Official

Name: MRS. DEBORAH CONDORELLI
Title or Position: VICE PRESIDENT FINANCE AND
Credential:
Phone: 200-767-0100