Provider Demographics
NPI:1477952695
Name:WOODBINE SENIOR LIVING, LLC
Entity Type:Organization
Organization Name:WOODBINE SENIOR LIVING, LLC
Other - Org Name:SPRING VILLAGE AT GALLOWAY
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:TUITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-404-1099
Mailing Address - Street 1:46 W JIMMIE LEEDS RD
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9401
Mailing Address - Country:US
Mailing Address - Phone:606-404-1099
Mailing Address - Fax:609-404-1477
Practice Address - Street 1:46 W JIMMIE LEEDS RD
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9401
Practice Address - Country:US
Practice Address - Phone:606-404-1099
Practice Address - Fax:609-404-1477
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WOODBINE SENIOR LIVING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-14
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ01A004310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility