Provider Demographics
NPI:1225047095
Name:HUNTERDON CARE CENTER
Entity Type:Organization
Organization Name:HUNTERDON CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:F
Authorized Official - Last Name:REVICKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-788-9292
Mailing Address - Street 1:1 LEISURE CT
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-5724
Mailing Address - Country:US
Mailing Address - Phone:908-788-9292
Mailing Address - Fax:908-788-0556
Practice Address - Street 1:1 LEISURE CT
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-5724
Practice Address - Country:US
Practice Address - Phone:908-788-9292
Practice Address - Fax:908-788-0556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ061007314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ000691OtherHORIZON BLUE CROSS
NJ4482301Medicaid
NJ4482301Medicaid