Provider Demographics
NPI:1508033911
Name:ABSECON MANOR NURSING HOME ASSOCIATES
Entity Type:Organization
Organization Name:ABSECON MANOR NURSING HOME ASSOCIATES
Other - Org Name:ABSECON MANOR NURSING & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLINEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:609-646-5400
Mailing Address - Street 1:1020 PITNEY RD
Mailing Address - Street 2:
Mailing Address - City:ABSECON
Mailing Address - State:NJ
Mailing Address - Zip Code:08201-9716
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1020 PITNEY RD
Practice Address - Street 2:
Practice Address - City:ABSECON
Practice Address - State:NJ
Practice Address - Zip Code:08201-9716
Practice Address - Country:US
Practice Address - Phone:609-646-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ060115314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4462815Medicaid