Provider Demographics
NPI:1003238130
Name:CRANFORD PARK REHABILITATION AND HEALTHCARE CENTER, LLC
Entity Type:Organization
Organization Name:CRANFORD PARK REHABILITATION AND HEALTHCARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:USHER
Authorized Official - Middle Name:
Authorized Official - Last Name:EGERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-276-7100
Mailing Address - Street 1:600 LINCOLN PARK EAST
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016
Mailing Address - Country:US
Mailing Address - Phone:908-276-7100
Mailing Address - Fax:
Practice Address - Street 1:600 LINCOLN PARK EAST
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016
Practice Address - Country:US
Practice Address - Phone:908-276-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-08
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ62005314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0410772Medicaid
NJ315390Medicare Oscar/Certification