Provider Demographics
NPI:1508936378
Name:SEABROOK VILLAGE, INC.
Entity Type:Organization
Organization Name:SEABROOK VILLAGE, INC.
Other - Org Name:SEABROOK VILLAGE, INC., HOME HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:RATHMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-402-2390
Mailing Address - Street 1:3000 ESSEX ROAD
Mailing Address - Street 2:ATTN: EXECUTIVE DIRECTOR
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-2631
Mailing Address - Country:US
Mailing Address - Phone:732-643-1200
Mailing Address - Fax:410-204-7237
Practice Address - Street 1:3000 ESSEX ROAD
Practice Address - Street 2:ATTN: HOME HEALTH ADMINISTRATOR
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07753-7775
Practice Address - Country:US
Practice Address - Phone:732-643-1200
Practice Address - Fax:410-204-7237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ24173251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
317093Medicare Oscar/Certification