Basic Information
| Provider Information | |||||||||
| NPI: | 1760142665 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THE GARDENS AT WAYNE POST ACUTE AND NURSING CENTER LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | EXCEL CARE AT WAYNE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14C 53RD ST | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112322644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8775670402 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 296 HAMBURG TPKE | ||||||||
| Address2: | |||||||||
| City: | WAYNE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074702150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737905800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2021 | ||||||||
| LastUpdateDate: | 02/17/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | STERN | ||||||||
| AuthorizedOfficialFirstName: | SAM | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 8775670402 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 313M00000X | N | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility | 385H00000X | N | Respite Care Facility | Respite Care | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.