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General NPI Number Information
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NPI Number | 1851492789
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Entity Type | Organization
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Legal Business Name | LIBERTY NURSING HOME OF JERSEY CITY INC
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 01/07/2010
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Provider Practice Location Address
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Address Line | 620 MONTGOMERY ST
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City | JERSEY CITY
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State | NJ
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Zip | 07302-3130
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Country | US
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Telephone | 201-435-0033
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Fax | 201-435-0655
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Provider Business Mailing Address
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Address Line | 620 MONTGOMERY ST
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City | JERSEY CITY
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State | NJ
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Zip | 07302-3130
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Country | US
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Telephone | 201-435-0033
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Fax | 201-435-0655
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Authorized Official
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Title or Position | CFO
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Name | MR. ISRAEL BRAUNSTEIN
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Credential |
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Telephone | 201-435-0033
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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 | 060903
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License Number State | NJ
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