Clover Rest Home Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

62104 Issued in NJ

Legal business name

CLOVER REST HOME INC

Practice address

28 Washington St
Columbia, NJ 07832-2324

Phone

(908) 496-4307

Fax

(908) 496-9420

NPI assigned

Dec 7, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Arthur W Robbins

Title

Controller

Phone

(908) 496-4307

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1133913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1033194626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 223",
            "address_2": "28 WASHINGTON ST.",
            "city": "COLUMBIA",
            "state": "NJ",
            "postal_code": "078320223",
            "telephone_number": "908-496-4307",
            "fax_number": "908-496-9420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28 WASHINGTON ST",
            "city": "COLUMBIA",
            "state": "NJ",
            "postal_code": "078322324",
            "telephone_number": "908-496-4307",
            "fax_number": "908-496-9420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLOVER REST HOME INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ROBBINS",
        "authorized_official_first_name": "ARTHUR",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "908-496-4307",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NJ",
            "license": "62104",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4506405",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.