Provider Demographics
NPI:1033778261
Name:GROESBECK HEALTHCARE RESIDENCE LLC
Entity Type:Organization
Organization Name:GROESBECK HEALTHCARE RESIDENCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-396-3462
Mailing Address - Street 1:111 CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-3342
Mailing Address - Country:US
Mailing Address - Phone:888-396-3462
Mailing Address - Fax:214-396-3462
Practice Address - Street 1:1025 W YEAGUA ST
Practice Address - Street 2:
Practice Address - City:GROESBECK
Practice Address - State:TX
Practice Address - Zip Code:76642-3529
Practice Address - Country:US
Practice Address - Phone:254-729-3366
Practice Address - Fax:254-729-3475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility