Provider Demographics
NPI:1619008646
Name:BRANCH BROOK PARK MANOR, INC.
Entity Type:Organization
Organization Name:BRANCH BROOK PARK MANOR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROCHELLE
Authorized Official - Middle Name:ANDREE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-481-6516
Mailing Address - Street 1:212 CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-1907
Mailing Address - Country:US
Mailing Address - Phone:973-481-6516
Mailing Address - Fax:973-481-0707
Practice Address - Street 1:212 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-1907
Practice Address - Country:US
Practice Address - Phone:973-481-6516
Practice Address - Fax:973-481-0707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility