# MANOR CARE OF MOUNTAINSIDE NJ LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** ProMedica Skilled Nursing and Rehabilitation (Mountainside)
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093757577
- **Authorized official:** MR. MARTIN D ALLEN (DIRECTOR)
- **Authorized official phone:** (419) 252-5743

## Contact information

- **Practice address:** 1180 ROUTE 22, MOUNTAINSIDE, NJ 07092-2810
- **Practice address phone:** (908) 654-0020
- **Practice address fax:** (908) 654-8661
- **Mailing address:** 333 N SUMMIT ST, TOLEDO, OH 43604-2615
- **Mailing address phone:** (419) 252-5500
- **Mailing address fax:** (877) 385-9446

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 062021 | NJ | Yes |

## Other

- **Enumeration date:** 06/11/2006
- **Last updated:** 01/24/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 4506201 | — | NJ |