Provider Demographics
NPI:1154328714
Name:EAGLE ROCK CONVALESCENT CENTER, INC.
Entity Type:Organization
Organization Name:EAGLE ROCK CONVALESCENT CENTER, INC.
Other - Org Name:WEST CALDWELL CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:PINELES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-489-7400
Mailing Address - Street 1:165 FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-6414
Mailing Address - Country:US
Mailing Address - Phone:973-226-1100
Mailing Address - Fax:973-226-5993
Practice Address - Street 1:165 FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-6414
Practice Address - Country:US
Practice Address - Phone:973-226-1100
Practice Address - Fax:973-226-5993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ060734314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ07750OtherNJ
NJ4477804Medicaid
NJ4477804Medicaid