Active NPI
Buckingham at Norwood Care and Rehabilitation Center LLC
- Skilled Nursing Facility
- Norwood, NJ
National Provider Identifier
1629074059
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 053334
- Legal business name
- BUCKINGHAM AT NORWOOD CARE AND REHABILITATION CENTER LLC
- Practice address
- 100 McClellen St
Norwood, NJ 07648-1555 - Phone
- (201) 768-6222
- Fax
- (201) 767-8354
- NPI assigned
- Jun 21, 2005
- 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
- Mrs. Deborah Condorelli
- Title
- VP Finance & Census Development
- Phone
- (201) 767-0100
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 053334 | NJ | Primary |
Addresses
Primary practice location
100 McClellen St
Norwood, NJ 07648-1555
Mailing address
100 McClellen St
Norwood, NJ 07648-1555
Phone (201) 767-0100
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8878005 | Medicaid | NJ |
Other names 1
- Heritage at Norwood
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NJ
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070924000362 | NJ | Part A Provider - Skilled Nursing Facility | 5597859314 | Practice locations: Norwood, NJ |
Skilled nursing facility certification: CCN 315290
- Legal name
- BUCKINGHAM AT NORWOOD CARE AND REHABILITATION CENTER LLC
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Feb 16, 1990
- Last certification
- Nov 7, 2024
- Beds
- 240
- Ownership / control type
- Limited Liability Corporation
- Organization structure
- LLC
- Incorporated
- Jan 18, 2002 in NJ
- Enrollment address
- 100 McClellen St
Norwood, NJ 07648-1555 - Nursing home name
- BUCKINGHAM AT NORWOOD, THE
- Affiliated entity
- EXCELCARE
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Buckingham at Norwood, the
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Feb 16, 1990
- Medicare certification status
- Active
- Certified beds
- 240
- Chain
- Excelcare
- Penalties (3 years)
- 1
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 |
|---|---|---|---|
| Trevor Dublin | W-2 Managing Employee | Dec 3, 2018 | 100% |
| Livia Jacobs | 5% Or Greater Direct Ownership Interest | Jan 18, 2002 | 5% |
| Hyman Jacobs | 5% Or Greater Direct Ownership Interest | Jan 18, 2002 | 95% |
| Christopher J Metternich | Corporate Officer | Aug 17, 2017 |
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Internal Medicine Physician
- Alpine, NJ
- NPI 1932125994
Affiliated clinicians 2
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": "1119312000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1237248000000",
"number": "1629074059",
"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": "100 MCCLELLEN ST",
"city": "NORWOOD",
"state": "NJ",
"postal_code": "076481555",
"telephone_number": "201-768-6222",
"fax_number": "201-767-8354"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BUCKINGHAM AT NORWOOD CARE AND 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 FINANCE & CENSUS DEVELOPMENT",
"authorized_official_telephone_number": "201-767-0100",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "NJ",
"license": "053334",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8878005",
"state": "NJ"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Heritage at Norwood",
"code": "4",
"type": "Former Legal Business Name"
}
]
}
Other providers in Norwood, NJ
Sources for this page
- 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.