Basic Information
| Provider Information | |||||||||
| NPI: | 1912120148 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HARTWYCK WEST NURSING HOME, INC | ||||||||
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| OtherOrganizationName: | JFK HARTWYCK AT CEDAR BROOK | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 98 JAMES ST | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | EDISON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088203902 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1340 PARK AVE | ||||||||
| Address2: | |||||||||
| City: | PLAINFIELD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070603227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9087543100 | ||||||||
| FaxNumber: | 9087543418 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2007 | ||||||||
| LastUpdateDate: | 08/15/2007 | ||||||||
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| AuthorizedOfficialLastName: | LANKEY | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | SR VP FOR LTC FACILITIES | ||||||||
| AuthorizedOfficialTelephone: | 7323217890 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 062009 | NJ | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 2021Y | 05 | NJ | MEDICAID | 20218 | 05 | NJ | MEDICAID | 4504305 | 05 | NJ | MEDICAID | 4505107 | 05 | NJ | MEDICAID |