Provider Demographics
NPI:1609860287
Name:CHESTNUT HILL CONVALESCENT CENTER
Entity Type:Organization
Organization Name:CHESTNUT HILL CONVALESCENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. DIRECTOR OF NURSING
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOURDES
Authorized Official - Middle Name:J
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:973-777-7800
Mailing Address - Street 1:360 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-3124
Mailing Address - Country:US
Mailing Address - Phone:973-777-7800
Mailing Address - Fax:973-778-9013
Practice Address - Street 1:360 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-3124
Practice Address - Country:US
Practice Address - Phone:973-777-7800
Practice Address - Fax:973-778-9013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4495900Medicaid
NJ4495900Medicaid