Provider Demographics
NPI:1962476705
Name:WOODCLIFF LAKE HEALTH & REHABILTATION CENTER, LLC
Entity Type:Organization
Organization Name:WOODCLIFF LAKE HEALTH & REHABILTATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:YARON
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGLESTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:201-391-0900
Mailing Address - Street 1:555 CHESTNUT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WOODCLIFF LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07677-8417
Mailing Address - Country:US
Mailing Address - Phone:201-391-0900
Mailing Address - Fax:201-391-1186
Practice Address - Street 1:555 CHESTNUT RIDGE RD
Practice Address - Street 2:
Practice Address - City:WOODCLIFF LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07677-8417
Practice Address - Country:US
Practice Address - Phone:201-391-0900
Practice Address - Fax:201-391-1186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-16
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ060221314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4463307Medicaid
NJ4463307Medicaid