Provider Demographics
NPI:1215356910
Name:EVA'S VILLAGE, INC.
Entity Type:Organization
Organization Name:EVA'S VILLAGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-523-6220
Mailing Address - Street 1:393 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07501-2815
Mailing Address - Country:US
Mailing Address - Phone:973-523-6220
Mailing Address - Fax:973-825-7297
Practice Address - Street 1:16 SPRING ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07501-2823
Practice Address - Country:US
Practice Address - Phone:973-754-6780
Practice Address - Fax:973-754-6794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1000093324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7199708Medicaid
NJ7632703Medicaid