Provider Demographics
NPI:1134288244
Name:KING MANOR REHAB, LLC
Entity Type:Organization
Organization Name:KING MANOR REHAB, LLC
Other - Org Name:KING MANOR CARE & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SHIMON
Authorized Official - Middle Name:D
Authorized Official - Last Name:FALIK
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:732-774-3500
Mailing Address - Street 1:2303 W BANGS AVE
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-4111
Mailing Address - Country:US
Mailing Address - Phone:732-774-3500
Mailing Address - Fax:732-774-5481
Practice Address - Street 1:2303 W BANGS AVE
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4111
Practice Address - Country:US
Practice Address - Phone:732-774-3500
Practice Address - Fax:732-774-5481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ061341314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4490509Medicaid
5905990001OtherMEDICARE NHIC
NJ4490509Medicaid