Provider Demographics
NPI:1033415740
Name:SOUTH JERSEY HEALTHCARE LIFE, INC.
Entity Type:Organization
Organization Name:SOUTH JERSEY HEALTHCARE LIFE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR, PACE
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PENDLETON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:856-878-6005
Mailing Address - Street 1:2445 S DELSEA DR
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-7000
Mailing Address - Country:US
Mailing Address - Phone:856-878-6005
Mailing Address - Fax:
Practice Address - Street 1:2950 COLLEGE DR
Practice Address - Street 2:SUITE 1E
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6933
Practice Address - Country:US
Practice Address - Phone:856-641-8624
Practice Address - Fax:856-641-8641
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH JERSEY HEALTH SYSTEM, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization