Provider Demographics
NPI:1760524052
Name:PRINCETON HEALTHCARE SYSTEM, A NEW JERSEY NON-PROFIT CORPORATION
Entity Type:Organization
Organization Name:PRINCETON HEALTHCARE SYSTEM, A NEW JERSEY NON-PROFIT CORPORATION
Other - Org Name:PENN MEDICINE HOMEHEALTH PRINCETON HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GUILLHERME
Authorized Official - Middle Name:SIMOES
Authorized Official - Last Name:VALLADARES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-853-7112
Mailing Address - Street 1:105 COLLEGE RD E FL 2
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-6622
Mailing Address - Country:US
Mailing Address - Phone:609-497-4900
Mailing Address - Fax:609-497-4933
Practice Address - Street 1:105 COLLEGE RD E FL 2
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-6622
Practice Address - Country:US
Practice Address - Phone:609-497-4900
Practice Address - Fax:609-497-4933
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRINCETON HEALTHCARE SYSTEM, A NEW JERSEY NON-PROFIT CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4145801Medicaid
NJ5905086OtherAETNA HOME CARE
NJ4145801Medicaid
NJ4145801Medicaid