MEDICARE: GREENWOOD HOUSE, HOME FOR THE JEWISH AGED INC.

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
1	314000000X	Skilled Nursing Facility	031101	NJ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	563991	OTHER	NJ	MEDICARE OSCAR FOR PHYSICIAN'S BILLING

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0469710001	OTHER	NJ	NSC NUMBER FOR PEN BILLIN

General Provider Information

NPI Number	:	1710986823
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENWOOD HOUSE, HOME FOR THE JEWISH AGED INC.

Provider Business Mailing Address
First Line	:	53 WALTER ST
Second Line	:
City	:	EWING
State	:	NJ
Zip	:	08628-3016
Country	:	US
Telephone Number	:	609-883-5391
Fax Number	:	609-530-1635

Provider Business Practice Location Address
First Line	:	53 WALTER ST
Second Line	:
City	:	EWING
State	:	NJ
Zip	:	08628-3016
Country	:	US
Telephone Number	:	609-883-5391
Fax Number	:	609-530-1635

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. RICHARD S GOLDSTEIN
Credential	:	LNHA
Telephone Number	:	609-883-5391

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	04/29/2008

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Directions to “GREENWOOD HOUSE, HOME FOR THE JEWISH AGED INC. ” Practice Location

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