Provider Demographics
NPI:1710069133
Name:VAN DYK HEALTHCARE, INC.
Entity Type:Organization
Organization Name:VAN DYK HEALTHCARE, INC.
Other - Org Name:VAN DYK MANOR OF RIDGEWOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MISS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MELCHIONDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-689-7991
Mailing Address - Street 1:644 GOFFLE RD
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07506-3452
Mailing Address - Country:US
Mailing Address - Phone:201-689-7991
Mailing Address - Fax:973-304-2046
Practice Address - Street 1:304 S VAN DIEN AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-5200
Practice Address - Country:US
Practice Address - Phone:201-689-7991
Practice Address - Fax:201-445-9535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ060227314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ315434Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER