Provider Demographics
NPI:1295190098
Name:UNIVERSAL REHABILITATION & FITNESS CENTER INC
Entity Type:Organization
Organization Name:UNIVERSAL REHABILITATION & FITNESS CENTER INC
Other - Org Name:UNIVERSAL INSTITUTE INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCUDILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-992-8181
Mailing Address - Street 1:15 MICROLAB RD STE 17
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-1699
Mailing Address - Country:US
Mailing Address - Phone:973-992-8181
Mailing Address - Fax:
Practice Address - Street 1:195 W MOUNT PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-2752
Practice Address - Country:US
Practice Address - Phone:973-758-1679
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7340401Medicaid
NJ7340401Medicaid