| Organization Name: | WANAQUE CONVALESCENT CENTER |
| NPI Number: | 1841351541 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROBERT J SALL (CEO) |
| Mailing Address: | 1433 Ringwood Ave Haskell |
| State: | NJ US |
| Postal Code: | 074201520 |
| Phone Number: | 9738392119 |
| Fax Number: | 9738395155 |
| NPI Enumeration Date: | 12/13/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3140N1450X |
| License Number: | 061628 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Nursing & Custodial Care Facilities |
| Taxonomy Classification: | Skilled Nursing Facility |
| Taxonomy Specialization: | Nursing Care, Pediatric |
| Taxonomy Definition: | A nursing care facility designed and staffed for the provision of nursing care and appropriate educational and habilitative/rehabilitative services to children with multiple, complex or profound disabilities that can not be cared for in a less restrictive environment. |