Basic Information
| Provider Information | |||||||||
| NPI: | 1366698920 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE PALACE REHABILITATION AND CARE CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | ROUTE 38 AND MILL ROAD | ||||||||
| Address2: | |||||||||
| City: | MAPLE SHADE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08052 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | RT 1 AND 18 | ||||||||
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| City: | NEW BRUNSWICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185670400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2008 | ||||||||
| LastUpdateDate: | 01/26/2009 | ||||||||
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| AuthorizedOfficialLastName: | KATZ | ||||||||
| AuthorizedOfficialFirstName: | CHAVIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7185670400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 0141283 | 05 | NJ | MEDICAID |