Provider Demographics
NPI:1306842737
Name:BRIARWOOD CARE & REHABILITATION CENTER
Entity Type:Organization
Organization Name:BRIARWOOD CARE & REHABILITATION CENTER
Other - Org Name:CARRIAGE HOUSE MANOR
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VP FINANCE & CENSUS DEVELOPEMENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:CONDORELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-767-0100
Mailing Address - Street 1:100 MCCLELLEN ST
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07648-1555
Mailing Address - Country:US
Mailing Address - Phone:201-767-0100
Mailing Address - Fax:201-781-1191
Practice Address - Street 1:901 ERNSTON RD
Practice Address - Street 2:
Practice Address - City:SOUTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08879-2000
Practice Address - Country:US
Practice Address - Phone:732-721-8200
Practice Address - Fax:732-721-8289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ061208314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01040344Medicaid
NJ4484304Medicaid
NJ4484304Medicaid