Provider Demographics
NPI:1942275706
Name:WHITE HOUSE HEALTHCARE AND REHABILITATION CENTER INC.
Entity Type:Organization
Organization Name:WHITE HOUSE HEALTHCARE AND REHABILITATION CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ELIEZER
Authorized Official - Middle Name:M
Authorized Official - Last Name:GROSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:973-672-6500
Mailing Address - Street 1:560 BERKELEY AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07050-2109
Mailing Address - Country:US
Mailing Address - Phone:973-672-6500
Mailing Address - Fax:973-672-6611
Practice Address - Street 1:560 BERKELEY AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07050-2109
Practice Address - Country:US
Practice Address - Phone:973-672-6500
Practice Address - Fax:973-672-6611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ60721314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4476301Medicaid
NJ4252940001Medicare NSC
NJ4476301Medicaid