Provider Demographics
NPI:1801997853
Name:ELMORA HILLS HEALTH & REHABILITATION CENTER,LLC
Entity type:Organization
Organization Name:ELMORA HILLS HEALTH & REHABILITATION CENTER,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ATTORNEY
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:FOGG
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:609-580-3702
Mailing Address - Street 1:225 W JERSEY ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-1301
Mailing Address - Country:US
Mailing Address - Phone:908-353-1220
Mailing Address - Fax:908-353-0102
Practice Address - Street 1:225 W JERSEY ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-1301
Practice Address - Country:US
Practice Address - Phone:908-353-1220
Practice Address - Fax:908-353-0102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4505808Medicaid
315010Medicare Oscar/Certification
5844470001Medicare NSC