Provider Demographics
NPI:1124435169
Name:ARCHWAY REHABILITATION CENTER, LLC
Entity type:Organization
Organization Name:ARCHWAY REHABILITATION CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:SCOTTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-676-6300
Mailing Address - Street 1:280 S HARRISON ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-1960
Mailing Address - Country:US
Mailing Address - Phone:973-676-6300
Mailing Address - Fax:973-766-1761
Practice Address - Street 1:280 S HARRISON ST
Practice Address - Street 2:SUITE 300
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-1960
Practice Address - Country:US
Practice Address - Phone:973-676-6300
Practice Address - Fax:973-766-1761
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DORSON HOME CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0060700251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7226403Medicaid