Provider Demographics
NPI:1427449537
Name:ALLENDALE NURSING HOME, INC
Entity type:Organization
Organization Name:ALLENDALE NURSING HOME, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:GIANCARLO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM, LNHA
Authorized Official - Phone:201-825-0660
Mailing Address - Street 1:85 HARRETON RD
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07401
Mailing Address - Country:US
Mailing Address - Phone:201-825-0660
Mailing Address - Fax:201-818-2031
Practice Address - Street 1:85 HARRETON RD
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:NJ
Practice Address - Zip Code:07401
Practice Address - Country:US
Practice Address - Phone:201-825-0660
Practice Address - Fax:201-818-2031
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLENDALE NURSING HOME, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0277983311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0277983Medicaid