Provider Demographics
NPI:1255404018
Name:ANDOVER SUBACUTE & REHAB CENTER SERVICES ONE INC
Entity type:Organization
Organization Name:ANDOVER SUBACUTE & REHAB CENTER SERVICES ONE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:TURCO
Authorized Official - Last Name:KIPIANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-460-8904
Mailing Address - Street 1:PO BOX 536
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-0536
Mailing Address - Country:US
Mailing Address - Phone:201-460-8904
Mailing Address - Fax:201-460-9925
Practice Address - Street 1:1 OBRIEN LANE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:NJ
Practice Address - Zip Code:07848
Practice Address - Country:US
Practice Address - Phone:973-383-6200
Practice Address - Fax:973-940-1178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4503708Medicaid
NJ315044Medicare ID - Type Unspecified