Provider Demographics
NPI:1700263910
Name:HW/WEIDCO/REN LLC
Entity Type:Organization
Organization Name:HW/WEIDCO/REN LLC
Other - Org Name:ASSISTED LIVING AT RENAISSANCE
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAUSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-455-2100
Mailing Address - Street 1:99 MANHEIM AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-2114
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:99 MANHEIM AVE
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-2114
Practice Address - Country:US
Practice Address - Phone:856-455-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25C001310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4473701Medicaid
NJ315061Medicare Oscar/Certification