Active NPI
Cornell Hall Care & Rehabilitation Center LLC
- Skilled Nursing Facility
- Union, NJ
National Provider Identifier
1528297868
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 062004
- Legal business name
- CORNELL HALL CARE & REHABILITATION CENTER LLC
- Practice address
- 234 Chestnut St
Union, NJ 07083-9409 - Phone
- (201) 767-0100
- NPI assigned
- Jul 8, 2009
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Edward S Neumann
- Title
- Cfo
- Phone
- (201) 767-0100
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 062004 | NJ | Primary |
Addresses
Primary practice location
234 Chestnut St
Union, NJ 07083-9409
Mailing address
100 McClellen St
Norwood, NJ 07648-1555
Phone (201) 767-0100
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4505905 | Medicaid | NJ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NJ
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100331000104 | NJ | Part A Provider - Skilled Nursing Facility | 8325174154 | Practice locations: Union, NJ |
Skilled nursing facility certification: CCN 315104
- Legal name
- CORNELL HALL CARE & REHABILITATION CENTER LLC
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jun 28, 1969
- Last certification
- Apr 16, 2025
- Beds
- 177
- Ownership / control type
- Limited Liability Corporation
- Most recent change of ownership
- Dec 21, 2009
- Organization structure
- LLC
- Incorporated
- Apr 30, 2009 in NJ
- Enrollment address
- 234 Chestnut Street
Union, NJ 07083-9409 - Nursing home name
- CORNELL HALL CARE & REHABILITATION CENTER
- Affiliated entity
- AUTUMN LAKE HEALTHCARE
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Cornell Hall Care & Rehabilitation Center
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Jun 28, 1969
- Medicare certification status
- Active
- Certified beds
- 177
- Chain
- Autumn Lake Healthcare
- Penalties (3 years)
- 14
National Provider Directory
National Provider DirectoryOwnership & related parties
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.
| Name | Role | Since | Share |
|---|---|---|---|
| Vicki Hayes | W-2 Managing Employee | Feb 26, 2015 | 100% |
| Livia Jacobs | 5% Or Greater Direct Ownership Interest | Apr 30, 2009 | 5% |
| Hyman Jacobs | 5% Or Greater Direct Ownership Interest | Apr 30, 2009 | 95% |
| Operational/Managerial Control | Dec 16, 2009 | ||
| Christopher J Metternich | Corporate Officer | Aug 17, 2017 | 100% |
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Medicine Physician
- North Bergen, NJ
- NPI 1770569568
-
- Student in an Organized Health Care Education/Training Program
- Cranford, NJ
- NPI 1144470600
Affiliated clinicians 4
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Internal Medicine Physician
- North Haledon, NJ
- NPI 1730112012
Nursing home
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1247011200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1247011200000",
"number": "1528297868",
"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"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "234 CHESTNUT ST",
"city": "UNION",
"state": "NJ",
"postal_code": "070839409",
"telephone_number": "201-767-0100"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CORNELL HALL CARE & REHABILITATION CENTER LLC",
"organizational_subpart": "NO",
"enumeration_date": "2009-07-08",
"last_updated": "2009-07-08",
"status": "A",
"authorized_official_last_name": "NEUMANN",
"authorized_official_first_name": "EDWARD",
"authorized_official_middle_name": "S",
"authorized_official_title_or_position": "CFO",
"authorized_official_telephone_number": "201-767-0100",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "NJ",
"license": "062004",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4505905",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Union, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.