Provider Demographics
NPI:1437191707
Name:STEVENS AVE HEALTHCARE CENTER LLC
Entity Type:Organization
Organization Name:STEVENS AVE HEALTHCARE CENTER LLC
Other - Org Name:NEWPORT NURSING AND REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMPTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:STERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-567-0400
Mailing Address - Street 1:170 53RD ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11232-4319
Mailing Address - Country:US
Mailing Address - Phone:718-567-0400
Mailing Address - Fax:718-567-0600
Practice Address - Street 1:198 STEVENS AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-2111
Practice Address - Country:US
Practice Address - Phone:201-451-9000
Practice Address - Fax:201-451-0609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ060909314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4479602Medicaid
NJ4479602Medicaid