Provider Demographics
NPI:1912243155
Name:HOMESTEAD REHABILITATION & HEALTH CARE CENTER, LLC
Entity Type:Organization
Organization Name:HOMESTEAD REHABILITATION & HEALTH CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DOVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GLENN
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:973-948-5400
Mailing Address - Street 1:129 MORRIS TPKE
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-4913
Mailing Address - Country:US
Mailing Address - Phone:973-948-5400
Mailing Address - Fax:973-948-3056
Practice Address - Street 1:129 MORRIS TPKE
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-4913
Practice Address - Country:US
Practice Address - Phone:973-948-5400
Practice Address - Fax:973-948-3056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-17
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ061905314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4503902Medicaid
NJ315378Medicare Oscar/Certification