Provider Demographics
NPI:1427031616
Name:DELLRIDGE CARE CENTER
Entity Type:Organization
Organization Name:DELLRIDGE CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNE-MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GAUNTLETT
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:201-265-5600
Mailing Address - Street 1:532 FARVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-4130
Mailing Address - Country:US
Mailing Address - Phone:201-265-5600
Mailing Address - Fax:201-261-3164
Practice Address - Street 1:532 FARVIEW AVE
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-4130
Practice Address - Country:US
Practice Address - Phone:201-265-5600
Practice Address - Fax:201-261-3164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ060207313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4464109Medicaid
NJ4464109Medicaid