NPIMap

Organization Active NPI

Burnt Tavern Rehabilitation and Health Care Ctr

  • Skilled Nursing Facility
  • Brick, NJ
National Provider Identifier
1851348627
Registry record updated Nov 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
061518 Issued in NJ
Legal business name
BURNT TAVERN REHABILITATION AND HEALTH CARE CTR
Doing business as
Burnt Tavern Convalescent Center
Practice address
1049 Burnt Tavern Rd
Brick, NJ 08724-1967
Phone
(732) 840-3700
Fax
(832) 840-0572
NPI assigned
May 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2014

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

Authorized official

Name
Mr. Douglas Kreil
Title
Administrator
Phone
(732) 840-3700

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X ZBBGDW NJ
Skilled Nursing Facility 314000000X 061518 NJ Primary

Addresses

Primary practice location

1049 Burnt Tavern Rd
Brick, NJ 08724-1967

Mailing address

1049 Burnt Tavern Rd
Brick, NJ 08724-1967
Phone (732) 840-3700

Other identifiers 3

IdentifierTypeStateIssuer
4494610MedicaidNJ
4494628MedicaidNJ
4494601MedicaidNJ

Other names 1

  • Burnt Tavern Convalescent Center Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415664000000",
    "number": "1851348627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1049 BURNT TAVERN RD",
            "city": "BRICK",
            "state": "NJ",
            "postal_code": "087241967",
            "telephone_number": "732-840-3700",
            "fax_number": "832-840-0572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1049 BURNT TAVERN RD",
            "city": "BRICK",
            "state": "NJ",
            "postal_code": "087241967",
            "telephone_number": "732-840-3700",
            "fax_number": "832-840-0572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BURNT TAVERN REHABILITATION AND HEALTH CARE CTR",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-27",
        "last_updated": "2014-11-11",
        "status": "A",
        "authorized_official_last_name": "KREIL",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "732-840-3700",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NJ",
            "license": "ZBBGDW",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NJ",
            "license": "061518",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4494610",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4494628",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4494601",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Burnt Tavern Convalescent Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brick, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.