HW Weidco Ren LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

060602 Issued in NJ

Legal business name

HW WEIDCO REN LLC

Doing business as

South Jersey Extended Care

Practice address

99 Manheim Ave
Bridgeton, NJ 08302-2114

Phone

(856) 455-2100

Fax

(856) 455-0960

NPI assigned

Aug 3, 2006

Last updated

Dec 12, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mark Weisz

Title

Member

Phone

(201) 488-6789

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• South Jersey Extended Care Doing business as

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720096035. Details of each certification follow.

• CCN 315061 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 315061

Legal name

HW WEIDCO REN LLC

Doing business as

SOUTH JERSEY EXTENDED CARE

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

May 1, 1980

Last certification

Jun 19, 2024

Beds

167

Ownership / control type

Limited Liability Corporation

Organization structure

LLCProprietary

Incorporated

Aug 29, 2002 in NJ

Enrollment address

99 Manheim Avenue
South Jersey Extended Care
Bridgeton, NJ 08302-2114

Nursing home name

SOUTH JERSEY EXTENDED CARE

Listed as

South Jersey Extended CareCCN 315061 · All quality measures

Overall star rating

3 of 5

Health inspections

2 of 5

Staffing

4 of 5

Quality measures

5 of 5

Type

Medicare and Medicaid

Ownership

For profit - Limited Liability company

Certified

May 1, 1980

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

16765.2 residents per day on average

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

Tax ID family

Assisted Living at Renaissance2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• HW/Weidco/Ren LLC

  • Assisted Living Facility
  • Bridgeton, NJ
  • NPI 1700263910
  NPD tax ID

All disclosed owners & managing parties 3

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

Practitioners 1

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.

• Raghuraj S Tomar, MD

  • Internal Medicine Physician
  • Vineland, NJ
  • NPI 1467412858
  NPD (past)

Affiliated clinicians 2

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

• Donald Carl Huston Jr., D.O.

  • Pulmonary Disease Physician
  • Glassboro, NJ
  • NPI 1316973563

  Nursing home

  Care Compare affiliation
• Raghuraj S Tomar, MD

  • Internal Medicine Physician
  • Vineland, NJ
  • NPI 1467412858

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1229040000000",
    "number": "1720096035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 UNIVERSITY PLZ",
            "address_2": "SUITE 206",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076016201",
            "telephone_number": "201-488-6789",
            "fax_number": "201-488-7734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "99 MANHEIM AVE",
            "city": "BRIDGETON",
            "state": "NJ",
            "postal_code": "083022114",
            "telephone_number": "856-455-2100",
            "fax_number": "856-455-0960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HW WEIDCO REN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-03",
        "last_updated": "2008-12-12",
        "status": "A",
        "authorized_official_last_name": "WEISZ",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "201-488-6789"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NJ",
            "license": "060602",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4473701",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Jersey Extended Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Paula Houck
• Teresa Houck, R.N
• Alex Huegel
• Ashleigh Huff, CPRS
• Ashley Humphrey, APN
• HW/Weidco/Ren LLC
• James G. Iannucci, M.D.
• Basil J Ingemi, MS PT CERTMDT
• Inspira Medical Centers, Inc. (Inspira Adolescent Intermediate Behavioral Care Unit Bridgeton)
• Inspira Medical Centers, Inc. (Inspira Medical Center OORP)

• Skilled Nursing Facility in Bridgeton, NJ
• Providers in Bridgeton, 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 Dec 12, 2008; 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.