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General NPI Number Information
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NPI Number | 1629512181
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Entity Type | Organization
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Legal Business Name | LEISURE CHATEAU REHAB HUNTINGTONS DISEASE
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Dates
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Enumeration Date | 12/16/2016
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Last Update Date | 12/16/2016
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Provider Practice Location Address
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Address Line | 962 RIVER AVE
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City | LAKEWOOD
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State | NJ
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Zip | 08701-5605
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Country | US
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Telephone | 732-370-8600
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Fax |
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Provider Business Mailing Address
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Address Line | 962 RIVER AVE
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City | LAKEWOOD
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State | NJ
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Zip | 08701-5605
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. SHIMON FALIK
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Credential |
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Telephone | 732-370-8600
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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 | 061515
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License Number State | NJ
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