Provider Demographics
NPI:1245235811
Name:LIVINGSTON CARE CENTER
Entity Type:Organization
Organization Name:LIVINGSTON CARE CENTER
Other - Org Name:INGLEMOOR CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:IZZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-994-1049
Mailing Address - Street 1:311 S LIVINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-3927
Mailing Address - Country:US
Mailing Address - Phone:973-994-0221
Mailing Address - Fax:973-992-0696
Practice Address - Street 1:311 S LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-3927
Practice Address - Country:US
Practice Address - Phone:973-994-0221
Practice Address - Fax:973-992-0696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ060708314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9057706Medicaid
NJ3153122Medicare ID - Type Unspecified