Basic Information
| Provider Information | |||||||||
| NPI: | 1528416856 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NORTHCREST ACRES NURSING & REHABILITATION CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 ROUTE 70 STE 3 | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087017406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7326591353 | ||||||||
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| Practice Location | |||||||||
| Address1: | 240 NORTHCREST DR | ||||||||
| Address2: | |||||||||
| City: | NAPOLEON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435457737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195994070 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2016 | ||||||||
| LastUpdateDate: | 11/04/2016 | ||||||||
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| AuthorizedOfficialLastName: | STERN | ||||||||
| AuthorizedOfficialFirstName: | JACOB | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 7326591353 | ||||||||
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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 |
No ID Information.