NPIMap

Organization Active NPI

Hackensack Meridian Ltach LLC

Doing business as Hackensack Meridian LTACH

  • Long Term Care Hospital
  • Perth Amboy, NJ
National Provider Identifier
1255022893
Registry record updated May 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care HospitalTaxonomy code 282E00000X
Legal business name
HACKENSACK MERIDIAN LTACH LLC
Doing business as
Hackensack Meridian LTACH
Practice address
530 New Brunswick Ave.
4TH Floor/Green
Perth Amboy, NJ 08861-3654
Phone
(732) 324-4714
NPI assigned
May 16, 2023
Last updated
May 16, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2023

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

Authorized official

Name
Michael Burns
Title
President
Phone
(732) 324-4714

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Hospital 282E00000X NU Primary

Addresses

Primary practice location

530 New Brunswick Ave.
4TH Floor/Green
Perth Amboy, NJ 08861-3654

Mailing address

399 Thornall St FL 2
Edison, NJ 08837-2236
Phone (732) 687-8785

Other names 1

  • Hackensack Meridian LTACH Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230927003090 NJ Part A Provider - Hospital 5991187973 Practice locations: Perth Amboy, NJ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1255022893. Details of each certification follow.

Hospital certification: CCN 312025

Legal name
HACKENSACK MERIDIAN LTACH LLC
Doing business as
HACKENSACK MERIDIAN LTACH LLC
Certification status
Active
Provider type (POS)
Hospital – Long-term
Participating since
Jan 1, 2024
Last certification
Jan 1, 2024
Beds
30
Ownership / control type
Private (not for profit)
Organization structure
LLCNon-profit
Incorporated
Jan 4, 2022 in NJ
Enrollment address
530 New Brunswick Ave
4TH Floor/Green
Perth Amboy, NJ 88613654
Main/Primary Hospital Location
Hospital subgroups
Long-term

Care Compare: Long-term care hospital

Medicare Care Compare
Listed as
Hackensack Meridian LtachCCN 312025 · All quality measures
Ownership
Non-profit
Certified
Jan 1, 2024
Medicare certification status
ActiveFrom the Provider of Services file
Beds
-

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 7

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Laura a Bianchini Individual Corporate DirectorBoard Member Jul 7, 2022
Michael Dagnes Individual Corporate DirectorBoard Member Jul 7, 2022
Hackensack Meridian Health Inc Organization, Edison, NJ Corporation, Non-profit 5% Or Greater Indirect Ownership Interest May 9, 2022 100%
Michael Burns Individual Corporate OfficerPresident Jul 7, 2022
Corporate DirectorBoard Member Jul 7, 2022
W-2 Managing EmployeePresident Jul 7, 2022
Patricia Carroll Individual Corporate DirectorBoard Member Jul 7, 2022
Jorge Gonzalez-Gomez Individual Corporate DirectorBoard Member Jul 7, 2022
HMH Hospitals Corporation Organization, Edison, NJ Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jul 1, 2016 100%

Owners & managing parties with NPI records 22

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

View all 22

Facilities with the same owner 25

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 25

Practitioners & affiliated clinicians

Affiliated clinicians 5

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1684195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684195200000",
    "number": "1255022893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "399 THORNALL ST FL 2",
            "city": "EDISON",
            "state": "NJ",
            "postal_code": "088372236",
            "telephone_number": "732-687-8785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 NEW BRUNSWICK AVE.",
            "address_2": "4TH FLOOR/GREEN",
            "city": "PERTH AMBOY",
            "state": "NJ",
            "postal_code": "088613654",
            "telephone_number": "732-324-4714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HACKENSACK MERIDIAN LTACH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-16",
        "last_updated": "2023-05-16",
        "certification_date": "2023-05-16",
        "status": "A",
        "authorized_official_last_name": "BURNS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "732-324-4714"
    },
    "taxonomies": [
        {
            "code": "282E00000X",
            "taxonomy_group": "",
            "desc": "Long Term Care Hospital",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hackensack Meridian LTACH",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Perth Amboy, NJ

Sources for this page

Verify at the official NPI Registry.