Provider Demographics
NPI:1619444221
Name:BERGEN POST ACUTE CARE, LLC
Entity Type:Organization
Organization Name:BERGEN POST ACUTE CARE, LLC
Other - Org Name:HACKENSACK MERIDIAN HEALTH PROSPECT HEIGHTS CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT DIVERSIFIED VENTURES
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEMAIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-751-7520
Mailing Address - Street 1:336 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-2506
Mailing Address - Country:US
Mailing Address - Phone:201-518-7800
Mailing Address - Fax:201-678-1801
Practice Address - Street 1:336 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601
Practice Address - Country:US
Practice Address - Phone:201-518-7800
Practice Address - Fax:201-678-1801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-01
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ315460OtherMEDICARE