Provider Demographics
NPI:1629403324
Name:BARNEGAT NURSING & REHAB LLC
Entity Type:Organization
Organization Name:BARNEGAT NURSING & REHAB LLC
Other - Org Name:BARNEGAT REHABILITATION AND NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:EHRENFELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-755-4047
Mailing Address - Street 1:325 JERSEY ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08611-3113
Mailing Address - Country:US
Mailing Address - Phone:516-507-8465
Mailing Address - Fax:
Practice Address - Street 1:859 W BAY AVE
Practice Address - Street 2:
Practice Address - City:BARNEGAT
Practice Address - State:NJ
Practice Address - Zip Code:08005-2127
Practice Address - Country:US
Practice Address - Phone:609-698-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-12
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ061524314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ061524OtherSTATE LICENSE
NJ315222Medicare Oscar/Certification