Provider Demographics
NPI:1376539742
Name:PRINCETON HEALTHCARE SNF, LLC
Entity Type:Organization
Organization Name:PRINCETON HEALTHCARE SNF, LLC
Other - Org Name:THE PAVILIONS AT FORRESTAL HEALTH AND REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LNHA
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PILEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-987-1221
Mailing Address - Street 1:5000 WINDROW DR
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-5003
Mailing Address - Country:US
Mailing Address - Phone:609-987-1221
Mailing Address - Fax:
Practice Address - Street 1:5000 WINDROW DR
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-5003
Practice Address - Country:US
Practice Address - Phone:609-987-1221
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
NJ62202314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ108324OtherAMERICAID
NJ5597641OtherAETNA
NJ7382707Medicaid
NJ315370OtherHORIZON BC/BS
NJ17620OtherWELLCHOICE OF NJ
NJ1157185OtherHORIZON NJ HEALTH
NJA1265483OtherOXFORD
NJ1157185OtherHORIZON NJ HEALTH