Provider Demographics
NPI:1033101795
Name:VIRTUA HEALTH AND REHABILITATION CENTER AT MOUNT. HOLLY, INC.
Entity Type:Organization
Organization Name:VIRTUA HEALTH AND REHABILITATION CENTER AT MOUNT. HOLLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-355-0004
Mailing Address - Street 1:20 W STOW RD
Mailing Address - Street 2:STE 8 - ATTENTION: CHRISTINE GORDON
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3160
Mailing Address - Country:US
Mailing Address - Phone:856-355-0655
Mailing Address - Fax:856-355-0621
Practice Address - Street 1:62 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:MT. HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060
Practice Address - Country:US
Practice Address - Phone:609-267-8800
Practice Address - Fax:609-914-7878
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIRTUA HEALTH INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-18
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ060310314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4466403Medicaid
NJ315128Medicare Oscar/Certification