Provider Demographics
NPI:1508348400
Name:FAMILY OF CARING HEALTHCARE AT RIDGEWOOD, LLC
Entity Type:Organization
Organization Name:FAMILY OF CARING HEALTHCARE AT RIDGEWOOD, LLC
Other - Org Name:FAMILY OF CARING AT VAN DYK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-391-0900
Mailing Address - Street 1:304 S VAN DIEN AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-5200
Mailing Address - Country:US
Mailing Address - Phone:201-445-8200
Mailing Address - Fax:201-445-9335
Practice Address - Street 1:304 S VAN DIEN AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450
Practice Address - Country:US
Practice Address - Phone:201-445-8200
Practice Address - Fax:201-445-9335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-06
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0659363Medicaid