Provider Demographics
NPI:1912120148
Name:HARTWYCK WEST NURSING HOME, INC
Entity Type:Organization
Organization Name:HARTWYCK WEST NURSING HOME, INC
Other - Org Name:JFK HARTWYCK AT CEDAR BROOK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP FOR LTC FACILITIES
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:LANKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-321-7890
Mailing Address - Street 1:98 JAMES ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3902
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1340 PARK AVE
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-3227
Practice Address - Country:US
Practice Address - Phone:908-754-3100
Practice Address - Fax:908-754-3418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ062009314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2021YMedicaid
NJ20218Medicaid
NJ4504305Medicaid
NJ4505107Medicaid
NJ4505107Medicaid