Provider Demographics
NPI:1740252162
Name:JEWISH GERIATRIC HOME
Entity type:Organization
Organization Name:JEWISH GERIATRIC HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:Z
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-667-3100
Mailing Address - Street 1:3025 CHAPEL AVE W
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-1503
Mailing Address - Country:US
Mailing Address - Phone:856-667-3100
Mailing Address - Fax:856-667-5042
Practice Address - Street 1:3025 CHAPEL AVE W
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-1503
Practice Address - Country:US
Practice Address - Phone:856-667-3100
Practice Address - Fax:856-667-5042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ060402314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4469500Medicaid
315068Medicare ID - Type UnspecifiedPROVIDER NUMBER