Organization
SKILES AVENUE AND STERLING DRIVE URBAN RENEWAL OPERATIONS LLC
Active
Parent organization
GENESIS NJ HOLDINGS LLC
Other names
POWERBACK REHABILITATION PISCATAWAY
Organization subpart
Yes
Provider details
NPI number
Legal business name
GENESIS NJ HOLDINGS LLC
Authorized official
MICHAEL THEODORE BERG (AUTHORIZED OFFICIAL)
(505) 468-4742
Entity
Organization
Contact information
Practice address
10 STERLING DR, PISCATAWAY, NJ 08854-4911
(732) 917-2900
(732) 917-2901
Mailing address
10 STERLING DR, PISCATAWAY, NJ 08854-4911
(732) 917-2900
(732) 917-2901
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0600458
—
NJ
01
—
1821532946
NPI FOR SNF
NJ
Enumeration date
05/31/2019
Last updated
05/31/2019
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