Provider Demographics
NPI:1912041526
Name:HEATH VILLAGE, INC.
Entity Type:Organization
Organization Name:HEATH VILLAGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARYELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOVE
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:908-684-5220
Mailing Address - Street 1:430 SCHOOLEYS MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-4039
Mailing Address - Country:US
Mailing Address - Phone:908-852-4801
Mailing Address - Fax:908-852-3748
Practice Address - Street 1:430 SCHOOLEYS MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-4039
Practice Address - Country:US
Practice Address - Phone:908-852-4801
Practice Address - Fax:908-852-3748
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEATH ALLIANCE FOR CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-16
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ031402314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4492609Medicaid
NJ4492609Medicaid