Provider Demographics
NPI:1790772267
Name:LEISURE CHATEAU ACQUISITION LLC
Entity Type:Organization
Organization Name:LEISURE CHATEAU ACQUISITION LLC
Other - Org Name:LEISURE CHATEAU REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROKEACH
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:732-370-8600
Mailing Address - Street 1:962 RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5605
Mailing Address - Country:US
Mailing Address - Phone:732-370-8600
Mailing Address - Fax:732-370-8676
Practice Address - Street 1:962 RIVER AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5605
Practice Address - Country:US
Practice Address - Phone:732-370-8600
Practice Address - Fax:732-370-8676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ061515314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5952870001OtherMEDICARE NHIC
NJ4493605Medicaid
NJ5952870001OtherMEDICARE NHIC
NJ4493605Medicaid