Provider Demographics
NPI:1073504411
Name:CAPE MAY COUNTY CREST HAVEN NURSING AND REHABILITATION CENTER
Entity type:Organization
Organization Name:CAPE MAY COUNTY CREST HAVEN NURSING AND REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:A
Authorized Official - Last Name:GANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-465-1260
Mailing Address - Street 1:4 MOORE RD
Mailing Address - Street 2:DN 619
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210-1654
Mailing Address - Country:US
Mailing Address - Phone:609-465-1260
Mailing Address - Fax:609-465-3427
Practice Address - Street 1:12 MOORE RD
Practice Address - Street 2:
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-1654
Practice Address - Country:US
Practice Address - Phone:609-465-1260
Practice Address - Fax:609-465-3427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ060501314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4471806Medicaid
NJ4471806Medicaid