Provider Demographics
NPI:1043370596
Name:LAUREL BAY HEALTH AND REHABILITATION CENTER
Entity Type:Organization
Organization Name:LAUREL BAY HEALTH AND REHABILITATION CENTER
Other - Org Name:BEACHVIEW CARE AND REHAB CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DENNIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-787-8100
Mailing Address - Street 1:32 LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:KEANSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:07734-1125
Mailing Address - Country:US
Mailing Address - Phone:732-787-8100
Mailing Address - Fax:732-787-9042
Practice Address - Street 1:32 LAUREL AVE
Practice Address - Street 2:
Practice Address - City:KEANSBURG
Practice Address - State:NJ
Practice Address - Zip Code:07734-1125
Practice Address - Country:US
Practice Address - Phone:732-787-8100
Practice Address - Fax:732-787-9042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ061333314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4489306Medicaid
NJ4489306Medicaid