Provider Demographics
NPI:1679690234
Name:M AND M REST HOME
Entity Type:Organization
Organization Name:M AND M REST HOME
Other - Org Name:M AND M MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CERTIFIED ASSISTED LIVING ADMIN
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE-WILIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:CALA, CMA, CNA
Authorized Official - Phone:732-446-6699
Mailing Address - Street 1:52 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-1504
Mailing Address - Country:US
Mailing Address - Phone:732-614-2730
Mailing Address - Fax:
Practice Address - Street 1:839 PERRINEVILLE RD
Practice Address - Street 2:
Practice Address - City:PERRINEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08535-1301
Practice Address - Country:US
Practice Address - Phone:732-446-6699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ031345302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8475806Medicaid