Provider Demographics
NPI:1912612508
Name:MOUNTAIN TOP REHABILITATION AND HEALTHCARE LLC
Entity Type:Organization
Organization Name:MOUNTAIN TOP REHABILITATION AND HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:SHAI
Authorized Official - Middle Name:
Authorized Official - Last Name:BERDUGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-474-6377
Mailing Address - Street 1:575 ROUTE 70 FL 2
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-4042
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:185 S MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN TOP
Practice Address - State:PA
Practice Address - Zip Code:18707-1921
Practice Address - Country:US
Practice Address - Phone:570-474-6377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility