Provider Demographics
NPI:1144227851
Name:SOMERSET VALLEY VISITING NURSE ASSOCIATION, INC.
Entity Type:Organization
Organization Name:SOMERSET VALLEY VISITING NURSE ASSOCIATION, INC.
Other - Org Name:COMMUNITY CARE HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ALYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-725-9355
Mailing Address - Street 1:110 W END AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-1824
Mailing Address - Country:US
Mailing Address - Phone:908-725-9355
Mailing Address - Fax:908-253-9672
Practice Address - Street 1:110 W END AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-1824
Practice Address - Country:US
Practice Address - Phone:908-725-9355
Practice Address - Fax:908-253-9672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22610251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3688526Medicaid
NJ311530Medicare Oscar/Certification