Provider Demographics
NPI:1134128309
Name:WANAQUE OPERATING CO, L.P.
Entity Type:Organization
Organization Name:WANAQUE OPERATING CO, L.P.
Other - Org Name:THE WANAQUE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR. ACCOUNT RECEIVABLE
Authorized Official - Prefix:MR
Authorized Official - First Name:LENARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-663-4044
Mailing Address - Street 1:1433 RINGWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:HASKELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07420-1520
Mailing Address - Country:US
Mailing Address - Phone:973-839-2119
Mailing Address - Fax:856-665-5708
Practice Address - Street 1:1114 WYNNWOOD AVE
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-3256
Practice Address - Country:US
Practice Address - Phone:856-663-4044
Practice Address - Fax:856-665-5708
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SENIORS MANAGEMENT NORTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-19
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ061628314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4495713OtherRES-PROV
NJ4496001Medicaid
NY01292924Medicaid
NJ4495705Medicaid
NJ0306070Medicaid
NY01057345Medicaid
NJ4495713OtherRES-PROV
NJ315229Medicare ID - Type Unspecified
NY01057345Medicaid