Provider Demographics
NPI:1306832779
Name:PARK RIDGE HEALTHCARE SNF, LLC
Entity Type:Organization
Organization Name:PARK RIDGE HEALTHCARE SNF, LLC
Other - Org Name:THE PLAZA REGENCY AT PARK RIDGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LNHA
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-505-1777
Mailing Address - Street 1:120 NOYES DR
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07656-1294
Mailing Address - Country:US
Mailing Address - Phone:201-505-1777
Mailing Address - Fax:
Practice Address - Street 1:120 NOYES DR
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07656-1294
Practice Address - Country:US
Practice Address - Phone:201-505-1777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ62219314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ60010170OtherHORIZON NJ HEALTH
NJ001006OtherHORIZON BC/BS (SUBACUTE)
NJ315438OtherHORIZON BC/BS (SKILLED)
NJ3226705OtherAETNA (HMO)
NJ108331OtherAMERICAID
NJ18406OtherWELLCHOICE OF NJ
NJ7399349OtherAETNA (TRADITIONAL)
NJ7667302Medicaid
NJ3226705OtherAETNA (HMO)