Provider Demographics
NPI:1669508032
Name:101 WHIPPANY ROAD LLC
Entity Type:Organization
Organization Name:101 WHIPPANY ROAD LLC
Other - Org Name:CRESTWOOD NURSING & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VP
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRESLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-242-4004
Mailing Address - Street 1:101 WHIPPANY RD
Mailing Address - Street 2:
Mailing Address - City:WHIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07981-1407
Mailing Address - Country:US
Mailing Address - Phone:973-887-0311
Mailing Address - Fax:973-887-8355
Practice Address - Street 1:101 WHIPPANY RD
Practice Address - Street 2:
Practice Address - City:WHIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07981-1407
Practice Address - Country:US
Practice Address - Phone:973-887-0311
Practice Address - Fax:973-887-8355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ315323Medicare ID - Type Unspecified