Basic Information
| Provider Information | |||||||||
| NPI: | 1194064683 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW EASTWOOD OPERATOR LP | ||||||||
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| OtherOrganizationName: | NEW EASTWOOD HEALTHCARE AND REHABILITATION CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 575 ROUTE 70 | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | BRICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087234042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7326065973 | ||||||||
| FaxNumber: | 7326082976 | ||||||||
| Practice Location | |||||||||
| Address1: | 2125 FAIRVIEW AVE | ||||||||
| Address2: | |||||||||
| City: | EASTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180423813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102582801 | ||||||||
| FaxNumber: | 6102580894 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2013 | ||||||||
| LastUpdateDate: | 04/16/2013 | ||||||||
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| AuthorizedOfficialLastName: | ROKEACH | ||||||||
| AuthorizedOfficialFirstName: | NACHUM | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 7322329217 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 050102 | PA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 1027826880001 | 05 | PA | MEDICAID |