Provider Demographics
NPI:1922094911
Name:STRATFORD NURSING AND CONVALESCENT CENTER, INC.
Entity Type:Organization
Organization Name:STRATFORD NURSING AND CONVALESCENT CENTER, INC.
Other - Org Name:STRATFORD NURSING CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:NEIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-784-2400
Mailing Address - Street 1:18 W LAUREL RD
Mailing Address - Street 2:P. O. BOX 613
Mailing Address - City:STRATFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08084-1718
Mailing Address - Country:US
Mailing Address - Phone:856-784-2400
Mailing Address - Fax:856-783-4594
Practice Address - Street 1:18 W LAUREL RD
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:NJ
Practice Address - Zip Code:08084-1718
Practice Address - Country:US
Practice Address - Phone:856-784-2400
Practice Address - Fax:856-783-4594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ060405314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4469402Medicaid
NJ315008Medicare ID - Type Unspecified