Provider Demographics
NPI:1962695478
Name:JEWISH HOME ASSISTED LIVING
Entity type:Organization
Organization Name:JEWISH HOME ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:STEFANCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-750-4232
Mailing Address - Street 1:685 WESTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-6335
Mailing Address - Country:US
Mailing Address - Phone:201-666-2370
Mailing Address - Fax:201-664-7111
Practice Address - Street 1:685 WESTWOOD AVE
Practice Address - Street 2:
Practice Address - City:RIVERVALE
Practice Address - State:NJ
Practice Address - Zip Code:07675-6335
Practice Address - Country:US
Practice Address - Phone:201-666-2370
Practice Address - Fax:201-664-7111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ02A00310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility