Provider Demographics
NPI:1235118514
Name:CHABRUSA CONVALESCENT CENTER, INC.
Entity type:Organization
Organization Name:CHABRUSA CONVALESCENT CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:OLSHALSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-843-7333
Mailing Address - Street 1:15 CALDWELL AVE
Mailing Address - Street 2:
Mailing Address - City:SADDLE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07663-6021
Mailing Address - Country:US
Mailing Address - Phone:201-843-7333
Mailing Address - Fax:201-843-6448
Practice Address - Street 1:15 CALDWELL AVE
Practice Address - Street 2:
Practice Address - City:SADDLE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07663-6021
Practice Address - Country:US
Practice Address - Phone:201-843-7333
Practice Address - Fax:201-843-6448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ60216314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4463803Medicaid
NJ4463803Medicaid