Provider Demographics
NPI:1487032652
Name:THE BAPTIST HOME OF SOUTH JERSEY
Entity Type:Organization
Organization Name:THE BAPTIST HOME OF SOUTH JERSEY
Other - Org Name:RIVERVIEW ESTATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAVO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-829-2274
Mailing Address - Street 1:303 BANK AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077-1113
Mailing Address - Country:US
Mailing Address - Phone:856-829-2274
Mailing Address - Fax:856-829-4873
Practice Address - Street 1:303 BANK AVE
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:NJ
Practice Address - Zip Code:08077-1113
Practice Address - Country:US
Practice Address - Phone:856-829-2274
Practice Address - Fax:856-829-4873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-08
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ10C000310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4466616Medicaid