Provider Demographics
NPI:1699892315
Name:MARGARET ANNA CUSACK CARE CENTER,INC
Entity type:Organization
Organization Name:MARGARET ANNA CUSACK CARE CENTER,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:201-653-8300
Mailing Address - Street 1:537 PAVONIA AVENUE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306
Mailing Address - Country:US
Mailing Address - Phone:201-653-8300
Mailing Address - Fax:201-653-7705
Practice Address - Street 1:537 PAVONIA AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-1803
Practice Address - Country:US
Practice Address - Phone:201-653-8300
Practice Address - Fax:201-653-7705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ030905314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4479904Medicaid
NJ4479904Medicaid