Provider Demographics
NPI:1063486108
Name:HOLY REDEEMER VISITING NURSE AGENCY
Entity Type:Organization
Organization Name:HOLY REDEEMER VISITING NURSE AGENCY
Other - Org Name:HOLY REDEEMER HOME CARE - NJ, SHORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:W
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-698-3726
Mailing Address - Street 1:6550 DELILAH RD
Mailing Address - Street 2:SUITE 501
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-5102
Mailing Address - Country:US
Mailing Address - Phone:609-761-0300
Mailing Address - Fax:609-761-3294
Practice Address - Street 1:6550 DELILAH RD
Practice Address - Street 2:SUITE 501
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-5102
Practice Address - Country:US
Practice Address - Phone:609-761-0300
Practice Address - Fax:609-761-3294
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOLY REDEEMER HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-15
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ70502251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ317066Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER