Provider Demographics
NPI:1811996093
Name:TRENTON CONVALESCENT CENTER OPERATING CO, L.P.
Entity type:Organization
Organization Name:TRENTON CONVALESCENT CENTER OPERATING CO, L.P.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:C.F.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:LENARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-663-4044
Mailing Address - Street 1:325 JERSEY ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08611-3113
Mailing Address - Country:US
Mailing Address - Phone:609-394-3400
Mailing Address - Fax:856-665-5708
Practice Address - Street 1:325 JERESY STREET
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08611-3113
Practice Address - Country:US
Practice Address - Phone:856-663-4044
Practice Address - Fax:856-665-5708
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SENIORS MANAGEMENT NORTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-19
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ061112314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4483405Medicaid
NJ4483413OtherRES-PROV
NJ315235Medicare Oscar/Certification
NJ4483413OtherRES-PROV
NJ4227120001Medicare NSC