Provider Demographics
NPI:1821085630
Name:COUNTY OF WARREN
Entity Type:Organization
Organization Name:COUNTY OF WARREN
Other - Org Name:WARREN HAVEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISOR OF ACCOUNTS
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TICHENOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-475-7709
Mailing Address - Street 1:350 OXFORD RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07863-3224
Mailing Address - Country:US
Mailing Address - Phone:908-475-7709
Mailing Address - Fax:908-475-7725
Practice Address - Street 1:350 OXFORD ROAD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NJ
Practice Address - Zip Code:07863-3224
Practice Address - Country:US
Practice Address - Phone:908-475-7709
Practice Address - Fax:908-475-7725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ62102314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4506707Medicaid
NJ4506707Medicaid