Provider Demographics
NPI:1619418951
Name:NJ DHS DIVISION OF AGING SERVICES
Entity Type:Organization
Organization Name:NJ DHS DIVISION OF AGING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:VALORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-588-2841
Mailing Address - Street 1:12D QUAKERBRIDGE PLZ
Mailing Address - Street 2:
Mailing Address - City:MERCERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-1241
Mailing Address - Country:US
Mailing Address - Phone:609-588-6537
Mailing Address - Fax:
Practice Address - Street 1:12D QUAKERBRIDGE PLZ
Practice Address - Street 2:ROOM D06
Practice Address - City:MERCERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08619-1241
Practice Address - Country:US
Practice Address - Phone:609-588-6537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF NEW JERSEY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care