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NPI Code Detail

MEDICARE: CANTERBURY AT CEDAR GROVE CARE & REHABILITATION CENTER LLC

MEDICARE: CANTERBURY AT CEDAR GROVE CARE & REHABILITATION CENTER LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility060729NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1407852833
Entity Type Code : Organization
Provider Name (Legal Business Name) : CANTERBURY AT CEDAR GROVE CARE & REHABILITATION CENTER LLC
Provider Business Mailing Address
First Line : 100 MCCLELLEN ST
Second Line :
City : NORWOOD
State : NJ
Zip : 07648-1555
Country : US
Telephone Number : 201-767-0100
Fax Number : 201-881-1191
Provider Business Practice Location Address
First Line : 398 POMPTON AVE
Second Line :
City : CEDAR GROVE
State : NJ
Zip : 07009-1813
Country : US
Telephone Number : 973-239-7600
Fax Number : 973-239-8725
Authorized Official
Title or Position : VP FINCANCE AND CENSUS DEVELOPEMENT
Name : MRS. DEBORAH CONDORELLI
Credential :
Telephone Number : 201-767-0100
Provider Enumeration Date : 06/21/2005
Last Update Date : 03/17/2009

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Directions to “CANTERBURY AT CEDAR GROVE CARE & REHABILITATION CENTER LLC ” Practice Location

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