Provider Demographics
NPI:1902895501
Name:NEWARK EXTENDED CARE FACILITY, INC.
Entity Type:Organization
Organization Name:NEWARK EXTENDED CARE FACILITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PANETH
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:973-483-6800
Mailing Address - Street 1:65 JAY ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-3235
Mailing Address - Country:US
Mailing Address - Phone:973-483-6800
Mailing Address - Fax:973-483-1841
Practice Address - Street 1:65 JAY ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-3235
Practice Address - Country:US
Practice Address - Phone:973-483-6800
Practice Address - Fax:973-483-1841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ060713314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4476204Medicaid
NJ4476204Medicaid