Provider Demographics
NPI:1588607725
Name:STATE OF NEW JERSEY OMB CENTRALIZED PAYROLL
Entity Type:Organization
Organization Name:STATE OF NEW JERSEY OMB CENTRALIZED PAYROLL
Other - Org Name:VINELAND DEVELOPMENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELOISE
Authorized Official - Middle Name:E
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:856-696-6007
Mailing Address - Street 1:PO BOX 1513
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08362-1513
Mailing Address - Country:US
Mailing Address - Phone:856-696-6000
Mailing Address - Fax:856-696-6056
Practice Address - Street 1:1676 E LANDIS AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08362-1513
Practice Address - Country:US
Practice Address - Phone:856-696-6000
Practice Address - Fax:856-696-6056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ528583OtherPROVIDER GROUP
NJ4474201Medicaid
NJ528583OtherPROVIDER GROUP