Provider Demographics
NPI:1174286009
Name:NEW JERSEY VETRANS MEMORIAL HOME
Entity Type:Organization
Organization Name:NEW JERSEY VETRANS MEMORIAL HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHARGE NURSE
Authorized Official - Prefix:
Authorized Official - First Name:MYRNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:RN MSN
Authorized Official - Phone:732-452-4138
Mailing Address - Street 1:132 EVERGREEN RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-2484
Mailing Address - Country:US
Mailing Address - Phone:732-452-4100
Mailing Address - Fax:
Practice Address - Street 1:132 EVERGREEN RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-2484
Practice Address - Country:US
Practice Address - Phone:732-452-4100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF NEW JERSEY NEW JERSEY VETERANS HOME MENLO PARK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff DevelopmentGroup - Multi-Specialty