# PARK RIDGE HEALTHCARE SNF, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** The Plaza Regency at Park Ridge
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306832779
- **Authorized official:** KATHLEEN MARTIN (LNHA)
- **Authorized official phone:** (201) 505-1777

## Contact information

- **Practice address:** 120 NOYES DR, PARK RIDGE, NJ 07656-1294
- **Practice address phone:** (201) 505-1777
- **Mailing address:** 120 NOYES DR, PARK RIDGE, NJ 07656-1294
- **Mailing address phone:** (201) 505-1777

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 62219 | NJ | Yes |

## Other

- **Enumeration date:** 09/21/2005
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 001006 | HORIZON BC/BS (SUBACUTE) | NJ |
| 01 | — | 108331 | AMERICAID | NJ |
| 01 | — | 18406 | WELLCHOICE OF NJ | NJ |
| 01 | — | 315438 | HORIZON BC/BS (SKILLED) | NJ |
| 01 | — | 3226705 | AETNA (HMO) | NJ |
| 01 | — | 60010170 | HORIZON NJ HEALTH | NJ |
| 01 | — | 7399349 | AETNA (TRADITIONAL) | NJ |
| 05 | — | 7667302 | — | NJ |