Provider Demographics
NPI:1578555140
Name:VIRTUA HEALTH & REHABILITATION CENTER AT BERLIN, INC.
Entity Type:Organization
Organization Name:VIRTUA HEALTH & REHABILITATION CENTER AT BERLIN, INC.
Other - Org Name:VIRTUA HEALTH AND REHABILITATION CENTER AT BERLIN INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PULLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-355-0004
Mailing Address - Street 1:20 W. STOW RD.
Mailing Address - Street 2:STE 8
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053
Mailing Address - Country:US
Mailing Address - Phone:856-355-0655
Mailing Address - Fax:856-355-0621
Practice Address - Street 1:100 LONG A COMING LN
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009-1964
Practice Address - Country:US
Practice Address - Phone:856-322-3684
Practice Address - Fax:856-322-3601
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIRTUA HEALTH INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-18
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ156001314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8121702Medicaid
NJ315461Medicare Oscar/Certification