Provider Demographics
NPI:1104965615
Name:JEWISH HOME AT ROCKLEIGH
Entity type:Organization
Organization Name:JEWISH HOME AT ROCKLEIGH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUNNI
Authorized Official - Middle Name:
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-750-4236
Mailing Address - Street 1:10 LINK DR
Mailing Address - Street 2:
Mailing Address - City:ROCKLEIGH
Mailing Address - State:NJ
Mailing Address - Zip Code:07647-2504
Mailing Address - Country:US
Mailing Address - Phone:201-784-1414
Mailing Address - Fax:201-750-4266
Practice Address - Street 1:10 LINK DR
Practice Address - Street 2:
Practice Address - City:ROCKLEIGH
Practice Address - State:NJ
Practice Address - Zip Code:07647-2504
Practice Address - Country:US
Practice Address - Phone:201-784-1414
Practice Address - Fax:201-750-4266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJJZ24OP314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ025304OtherWELLCOICE NEW JERSEY ID
NJ7773498OtherAETNA PPO ID
NJ8749001Medicaid
NJ3223879OtherAETNA HMO ID
NJ7773498OtherAETNA PPO ID