Clark Nursing and Rehabilitation Center, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

062211 Issued in NJ

Legal business name

CLARK NURSING AND REHABILITATION CENTER, LLC

Practice address

1213 Westfield Ave
Clark, NJ 07066-1323

Phone

(732) 396-7100

Fax

(732) 396-1924

NPI assigned

Mar 29, 2017

Last updated

Mar 29, 2017By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Gary Santo

Title

Administrator

Phone

(732) 396-7100

Specialties & licenses 1

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1490745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490745600000",
    "number": "1023540127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1213 WESTFIELD AVE",
            "city": "CLARK",
            "state": "NJ",
            "postal_code": "070661323",
            "telephone_number": "732-396-7100",
            "fax_number": "732-396-1924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1213 WESTFIELD AVE",
            "city": "CLARK",
            "state": "NJ",
            "postal_code": "070661323",
            "telephone_number": "732-396-7100",
            "fax_number": "732-396-1924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARK NURSING AND REHABILITATION CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-29",
        "last_updated": "2017-03-29",
        "status": "A",
        "authorized_official_last_name": "SANTO",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "732-396-7100",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NJ",
            "license": "062211",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6468209",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VENTILATOR UNIT -MEDICAID (MOLINA) #",
            "identifier": "6468217",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Clark Board of Education
• Clark Community Pharmacy LLC
• Clark Dermatology LLC (Metropolitan Dermatology)
• Clark Diagnostics LLC
• Clark Nursing and Rehabilitation Center LLC
• Clark Pediatrics, LLC
• Clark Psychology Center (Clark Psychology)
• Clark Rehab Services LLC
• Clark Volunteer Emergency Squad Inc
• CMLC ABA, LLC

• Skilled Nursing Facility in Clark, NJ
• Providers in Clark, NJ by specialty
• Skilled Nursing Facility in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.