Provider Demographics
NPI:1891952743
Name:MERIDIAN NURSING AND REHABILITATION INC
Entity Type:Organization
Organization Name:MERIDIAN NURSING AND REHABILITATION INC
Other - Org Name:BAYSHORE HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR LTC ACCOUNT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-751-3624
Mailing Address - Street 1:3349 HWY 138 BLDG C
Mailing Address - Street 2:SUITE A
Mailing Address - City:WALL TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-9671
Mailing Address - Country:US
Mailing Address - Phone:732-751-3600
Mailing Address - Fax:732-751-3649
Practice Address - Street 1:715 N BEERS ST
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1503
Practice Address - Country:US
Practice Address - Phone:732-847-3000
Practice Address - Fax:732-847-3794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0388033Medicaid
NJ4490614Medicaid
NJ0388033Medicaid
NJ0481130001Medicare NSC