Provider Demographics
NPI:1699018242
Name:EVA'S VILLAGE, INC.
Entity Type:Organization
Organization Name:EVA'S VILLAGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-523-6220
Mailing Address - Street 1:393 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07501-2815
Mailing Address - Country:US
Mailing Address - Phone:973-523-6220
Mailing Address - Fax:973-825-7297
Practice Address - Street 1:20 JACKSON STREET
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07501-2815
Practice Address - Country:US
Practice Address - Phone:973-523-6220
Practice Address - Fax:973-825-7297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-02
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7199708Medicaid