Provider Demographics
NPI:1508959214
Name:JDL HEALTHCARE INC
Entity Type:Organization
Organization Name:JDL HEALTHCARE INC
Other - Org Name:ASBURY PARK NURSING & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:CROOKS
Authorized Official - Last Name:FIFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-649-2000
Mailing Address - Street 1:2257 FAIR OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-5501
Mailing Address - Country:US
Mailing Address - Phone:916-649-2000
Mailing Address - Fax:916-649-2244
Practice Address - Street 1:2257 FAIR OAKS BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-5501
Practice Address - Country:US
Practice Address - Phone:916-649-2000
Practice Address - Fax:916-649-2244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC55673GMedicaid
CA555673Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER