Provider Demographics
NPI:1326367228
Name:HALLMARK HEALTHCARE LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:HALLMARK HEALTHCARE LIMITED LIABILITY COMPANY
Other - Org Name:PINE ACRES CONVALESCENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MOSHE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRODT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-379-8074
Mailing Address - Street 1:51 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940-1411
Mailing Address - Country:US
Mailing Address - Phone:973-377-2124
Mailing Address - Fax:
Practice Address - Street 1:51 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940-1411
Practice Address - Country:US
Practice Address - Phone:973-377-2124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-18
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ061413314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ315053Medicare Oscar/Certification