Provider Demographics
NPI:1881623908
Name:ALLENDALE NURSING HOME INC
Entity type:Organization
Organization Name:ALLENDALE NURSING HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:R
Authorized Official - Last Name:GIANCARLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-825-0660
Mailing Address - Street 1:85 HARRETON RD
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07401-1317
Mailing Address - Country:US
Mailing Address - Phone:201-825-0660
Mailing Address - Fax:201-825-0377
Practice Address - Street 1:85 HARRETON RD
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:NJ
Practice Address - Zip Code:07401-1317
Practice Address - Country:US
Practice Address - Phone:201-825-0660
Practice Address - Fax:201-825-0377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ060201314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ31-5497Medicaid
NJ31-5497Medicare ID - Type Unspecified