Provider Demographics
NPI:1467515411
Name:PHYLCO, LTD
Entity Type:Organization
Organization Name:PHYLCO, LTD
Other - Org Name:WHITE BIRCH NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-942-8899
Mailing Address - Street 1:59 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07522-1403
Mailing Address - Country:US
Mailing Address - Phone:973-942-8899
Mailing Address - Fax:973-942-1229
Practice Address - Street 1:59 BIRCH ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07522-1403
Practice Address - Country:US
Practice Address - Phone:973-942-8899
Practice Address - Fax:973-942-1229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ061620314000000X
314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ001263OtherMEDICARE BLUE NUMBER
NJ4496701Medicaid
NJ4496701Medicaid