NPIMap

Organization Active NPI

Manor Care-West Deptford of Paulsboro NJ LLC

Doing business as ManorCare Health Services

  • Skilled Nursing Facility
  • Paulsboro, NJ
National Provider Identifier
1114962073
Registry record updated Jan 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
060807 Issued in NJ
Legal business name
MANOR CARE-WEST DEPTFORD OF PAULSBORO NJ LLC
Doing business as
ManorCare Health Services
Practice address
550 Jessup Rd
Paulsboro, NJ 08066-1921
Phone
(856) 848-9551
Fax
(856) 848-1817
NPI assigned
Jun 17, 2006
Last updated
Jan 17, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2022

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

Authorized official

Name
Mr. Martin D Allen
Title
Director
Phone
(419) 252-5743

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 060807 NJ Primary

Addresses

Primary practice location

550 Jessup Rd
Paulsboro, NJ 08066-1921

Mailing address

333 N Summit St
Toledo, OH 43604-2615
Phone (419) 252-5500

Other identifiers 1

IdentifierTypeStateIssuer
4478509MedicaidNJ

Other names 1

  • ManorCare Health Services Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Ability Network

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1150502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642377600000",
    "number": "1114962073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 N SUMMIT ST",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436042615",
            "telephone_number": "419-252-5500",
            "fax_number": "877-385-9446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 JESSUP RD",
            "city": "PAULSBORO",
            "state": "NJ",
            "postal_code": "080661921",
            "telephone_number": "856-848-9551",
            "fax_number": "856-848-1817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANOR CARE-WEST DEPTFORD OF PAULSBORO NJ LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-17",
        "last_updated": "2022-01-17",
        "certification_date": "2022-01-17",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "419-252-5743",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NJ",
            "license": "060807",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4478509",
            "state": "NJ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "ManorCare Health Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ManorCare Health Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Paulsboro, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2022; 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.