Provider Demographics
NPI:1790191526
Name:WANAQUE NURSING & REHABILITATION LLC
Entity Type:Organization
Organization Name:WANAQUE NURSING & REHABILITATION LLC
Other - Org Name:THE WANAQUE CENTER FOR NURSING & REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING 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:718-755-4047
Mailing Address - Fax:
Practice Address - Street 1:1433 RINGWOOD AVE
Practice Address - Street 2:
Practice Address - City:HASKELL
Practice Address - State:NJ
Practice Address - Zip Code:07420-1520
Practice Address - Country:US
Practice Address - Phone:973-839-2119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0616283140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric