Provider Demographics
NPI:1780775635
Name:NORTH BERGEN HEALTHCARE, LLC
Entity type:Organization
Organization Name:NORTH BERGEN HEALTHCARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:WRUBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-809-2890
Mailing Address - Street 1:9020 WALL ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-6011
Mailing Address - Country:US
Mailing Address - Phone:201-809-2890
Mailing Address - Fax:
Practice Address - Street 1:9020 WALL ST
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-6011
Practice Address - Country:US
Practice Address - Phone:201-861-4040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ060902314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4478801Medicaid
NJ315112Medicare Oscar/Certification
NJ5911180001Medicare NSC