Provider Demographics
NPI:1508801903
Name:JANSEN ROAD NURSING AND REHABILITATION CENTER LLC
Entity Type:Organization
Organization Name:JANSEN ROAD NURSING AND REHABILITATION CENTER LLC
Other - Org Name:THE MOUNTAIN VIEW NURSING AND REHABILITATION CENTRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-346-9640
Mailing Address - Street 1:1 JANSEN RD
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-3811
Mailing Address - Country:US
Mailing Address - Phone:845-255-0830
Mailing Address - Fax:845-255-0855
Practice Address - Street 1:1 JANSEN RD
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-3811
Practice Address - Country:US
Practice Address - Phone:845-255-0830
Practice Address - Fax:845-255-0855
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DMN MANAGEMENT SERVICES , LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-19
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5522302N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10054923OtherCDPHP
NY302056OtherWELLCARE
NY000400690009OtherBLUE SHIELD
NY956381OtherMVP
NY00311064Medicaid
NY007991OtherEMPIRE BC
NY00311064Medicaid