Provider Demographics
NPI:1013903103
Name:JERSEY SHORE CONVALESCENT CENTER
Entity Type:Organization
Organization Name:JERSEY SHORE CONVALESCENT CENTER
Other - Org Name:MEDICENTER/NEPTUNE CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:BROWNING
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:732-774-8300
Mailing Address - Street 1:2050 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-6124
Mailing Address - Country:US
Mailing Address - Phone:732-774-8300
Mailing Address - Fax:732-774-0908
Practice Address - Street 1:2050 SIXTH AVE
Practice Address - Street 2:
Practice Address - City:NEPTUNE CITY
Practice Address - State:NJ
Practice Address - Zip Code:07753-6124
Practice Address - Country:US
Practice Address - Phone:732-774-8300
Practice Address - Fax:732-774-0908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ061317314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4488407Medicaid
NJ315105Medicare Oscar/Certification