Provider Demographics
NPI:1336141266
Name:MOORESTOWN VISITING NURSE ASSOCIATION INC
Entity Type:Organization
Organization Name:MOORESTOWN VISITING NURSE ASSOCIATION INC
Other - Org Name:THE HOSPICE OF MOORESTOWN VNA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-552-1300
Mailing Address - Street 1:300 HARPER DR
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3208
Mailing Address - Country:US
Mailing Address - Phone:856-552-1300
Mailing Address - Fax:856-552-1314
Practice Address - Street 1:300 HARPER DR
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3208
Practice Address - Country:US
Practice Address - Phone:856-552-1300
Practice Address - Fax:856-552-1314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ23035251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8788502Medicaid
NJ311551Medicare ID - Type Unspecified