Canterbury at Cedar Grove Care & Rehabilitation Center LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

060729 Issued in NJ

Legal business name

CANTERBURY AT CEDAR GROVE CARE & REHABILITATION CENTER LLC

Practice address

398 Pompton Ave
Cedar Grove, NJ 07009-1813

Phone

(973) 239-7600

Fax

(973) 239-8725

NPI assigned

Jun 21, 2005

Organization subpart

No

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

Authorized official

Name

Mrs. Deborah Condorelli

Title

VP Fincance and Census Developement

Phone

(201) 767-0100

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Cedar Grove Manor Former legal business name

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Skilled nursing facility certification: CCN 315204

Legal name

CANTERBURY AT CEDAR GROVE CARE & REHABILITATION CENTER LLC

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Sep 1, 1984

Last certification

Jul 3, 2024

Beds

180

Ownership / control type

Limited Liability Corporation

Organization structure

LLCProprietary

Incorporated

Jan 18, 2002 in NJ

Enrollment address

398 Pompton Avenue
Cedar Grove, NJ 07009-1813

Nursing home name

CANTERBURY AT CEDAR GROVE

Affiliated entity

MB HEALTHCARE

Listed as

Canterbury at Cedar GroveCCN 315204

Overall star rating

3 of 5

Health inspections

3 of 5

Staffing

3 of 5

Quality measures

4 of 5

Type

Medicare and Medicaid

Ownership

For profit - Limited Liability company

Certified

Sep 1, 1984

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

180143.4 residents per day on average

Chain

MB Healthcare12 facilities in the chain

Penalties (3 years)

1Fines totaling $9,661

Processed by Care Compare on Aug 1, 2026.

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

All disclosed owners & managing parties 4

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

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Aiza Akbar, M.D.

  • Internal Medicine Physician
  • Glen Ridge, NJ
  • NPI 1588117576
  NPD (past)
• David S. Haacker, MD

  • Internal Medicine Physician
  • West Orange, NJ
  • NPI 1902879000
  NPD (past)

Affiliated clinicians 6

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

• Aiza Akbar, M.D.

  • Internal Medicine Physician
  • Glen Ridge, NJ
  • NPI 1588117576

  Nursing home

  Care Compare affiliation
• James N Ezema, MD

  • Internal Medicine Physician
  • East Orange, NJ
  • NPI 1003818881

  Nursing home

  Care Compare affiliation
• Kavita Gupta, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Cedar Grove, NJ
  • NPI 1073833554

  Nursing home

  Care Compare affiliation
• David S. Haacker, MD

  • Internal Medicine Physician
  • West Orange, NJ
  • NPI 1902879000

  Nursing home

  Care Compare affiliation
• Ramez Wadie Samuel, M.D.

  • Internal Medicine Physician
  • Newark, NJ
  • NPI 1447303417

  Nursing home

  Care Compare affiliation
• Valentine Okechukwu Obi, MD

  • Internal Medicine Physician
  • Staten Island, NY
  • NPI 1639524937

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1119312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237248000000",
    "number": "1407852833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MCCLELLEN ST",
            "city": "NORWOOD",
            "state": "NJ",
            "postal_code": "076481555",
            "telephone_number": "201-767-0100",
            "fax_number": "201-881-1191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "398 POMPTON AVE",
            "city": "CEDAR GROVE",
            "state": "NJ",
            "postal_code": "070091813",
            "telephone_number": "973-239-7600",
            "fax_number": "973-239-8725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANTERBURY AT CEDAR GROVE CARE & REHABILITATION CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-21",
        "last_updated": "2009-03-17",
        "status": "A",
        "authorized_official_last_name": "CONDORELLI",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_title_or_position": "VP FINCANCE AND CENSUS DEVELOPEMENT",
        "authorized_official_telephone_number": "201-767-0100",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NJ",
            "license": "060729",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8864501",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cedar Grove Manor",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Andrea Lisbeth Buccino, D.C.
• Jeff Edward Burrowes, DC
• C&S Deantal Enterprises
• Beth Valerie Cacossa-Madsen, DMD
• Christopher Raymond Cannara, AGPCNP
• Canterbury Healthcare and Rehab Center LLC
• Zina B. Cappiello, D.P.M.
• Care Chiropractic LLC
• Heather Carew, LCSW, BCBA
• Lisa Marie Cassilli, LPC, NCC, SAC

• Skilled Nursing Facility in Cedar Grove, NJ
• Providers in Cedar Grove, 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 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.