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General NPI Number Information
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NPI Number | 1306832779
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Entity Type | Organization
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Legal Business Name | PARK RIDGE HEALTHCARE SNF, LLC
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Dates
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Enumeration Date | 09/21/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 120 NOYES DR
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City | PARK RIDGE
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State | NJ
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Zip | 07656-1294
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Country | US
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Telephone | 201-505-1777
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Fax |
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Provider Business Mailing Address
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Address Line | 120 NOYES DR
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City | PARK RIDGE
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State | NJ
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Zip | 07656-1294
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Country | US
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Telephone | 201-505-1777
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Fax |
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Authorized Official
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Title or Position | LNHA
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Name | KATHLEEN MARTIN
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Credential |
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Telephone | 201-505-1777
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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 | 62219
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License Number State | NJ
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