Provider Demographics
NPI:1508307216
Name:BROADWAY HOUSE FOR CONTINUING CARE
Entity Type:Organization
Organization Name:BROADWAY HOUSE FOR CONTINUING CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:973-268-9797
Mailing Address - Street 1:298 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-8000
Mailing Address - Country:US
Mailing Address - Phone:973-268-9797
Mailing Address - Fax:973-268-2828
Practice Address - Street 1:298 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-8000
Practice Address - Country:US
Practice Address - Phone:973-268-9797
Practice Address - Fax:973-268-2828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ060738314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6400400Medicaid