Basic Information
| Provider Information | |||||||||
| NPI: | 1780670125 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CASCADE CORPORATION | ||||||||
| LastName: | |||||||||
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| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | EASTERN SHORE NURSING AND REHAB | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1419 N ROUTE 9 | ||||||||
| Address2: | |||||||||
| City: | CAPE MAY COURT HOUSE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082101415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6094652260 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1419 N ROUTE 9 | ||||||||
| Address2: | |||||||||
| City: | CAPE MAY COURT HOUSE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082101415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6094652260 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2005 | ||||||||
| LastUpdateDate: | 08/02/2011 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | PAYNE | ||||||||
| AuthorizedOfficialFirstName: | GRETAJO | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | LNHA | ||||||||
| AuthorizedOfficialTelephone: | 6094652260 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 060506 | NJ | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 01000356200 | 01 | NJ | AMERICHOICE | OTHER | 4471504 | 05 | NJ | MEDICAID | 92609 | 01 | NJ | AMERICAID | OTHER | 000660 | 01 | NJ | HORIZON BCBS (SUBACUTE) | OTHER | 0075701 | 05 | NJ | MEDICAID | 0005669000 | 01 | NJ | AMERIHEALTH | OTHER | 315197 | 01 | NJ | HORIZON BCBS (SKILLED) | OTHER | 500260 | 01 | NJ | AETNA | OTHER |