Provider Demographics
NPI:1023013786
Name:CRANBURY HEALTHCARE CENTER, INC.
Entity Type:Organization
Organization Name:CRANBURY HEALTHCARE CENTER, INC.
Other - Org Name:THE ELMS OF CRANBURY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:EVJU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-395-0641
Mailing Address - Street 1:61 MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CRANBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08512-3237
Mailing Address - Country:US
Mailing Address - Phone:609-395-0641
Mailing Address - Fax:609-395-8200
Practice Address - Street 1:61 MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:CRANBURY
Practice Address - State:NJ
Practice Address - Zip Code:08512-3237
Practice Address - Country:US
Practice Address - Phone:609-395-0641
Practice Address - Fax:609-395-8200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ061211313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ315451OtherBCBS ID
NJ4484401Medicaid
NJ000928OtherBCBS ID
NJ4484401Medicaid