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General NPI Number Information
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NPI Number | 1134288244
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Entity Type | Organization
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Legal Business Name | KING MANOR REHAB, LLC
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 11/30/2007
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Provider Practice Location Address
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Address Line | 2303 W BANGS AVE
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City | NEPTUNE
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State | NJ
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Zip | 07753-4111
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Country | US
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Telephone | 732-774-3500
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Fax | 732-774-5481
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Provider Business Mailing Address
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Address Line | 2303 W BANGS AVE
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City | NEPTUNE
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State | NJ
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Zip | 07753-4111
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Country | US
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Telephone | 732-774-3500
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Fax | 732-774-5481
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. SHIMON D FALIK
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Credential | LNHA
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Telephone | 732-774-3500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 061341
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License Number State | NJ
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