- Enrollment id
- O20200305000303
- Enrollment state
- NJ
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1679112023
- Multiple npi flag
- N
- Ccn
- 315229
- Associate id
- 1951738871
- Organization name
- NORTH JERSEY PEDIATRIC AND ADULT NURSING AND WELLNESS CENTER, LLC
- Doing business as name
- PHOENIX CENTER FOR REHABILITATION AND PEDIATRICS
- Incorporation date
- 2020-01-01
- Incorporation state
- NJ
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- PHOENIX CENTER FOR REHABILITATION AND PEDIATRICS
- Affiliation entity name
- PHILOSOPHY CARE CENTERS
- Affiliation entity id
- 400
- Address line 1
- 1433 RINGWOOD AVENUE
- City
- HASKELL
- State
- NJ
- Zip code
- 074201520