Provider Demographics
NPI:1326506684
Name:CLOVER MEADOWS HEALTHCARE AND REHABILITATION CENTER LLC
Entity Type:Organization
Organization Name:CLOVER MEADOWS HEALTHCARE AND REHABILITATION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
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:732-813-0030
Mailing Address - Street 1:1593 ROUTE 88
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-2386
Mailing Address - Country:US
Mailing Address - Phone:732-813-0030
Mailing Address - Fax:
Practice Address - Street 1:112 FRANKLIN CORNER RD
Practice Address - Street 2:
Practice Address - City:LAWRENCE TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08648-2104
Practice Address - Country:US
Practice Address - Phone:723-813-0030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility