Provider Demographics
NPI:1922004613
Name:VIRTUA - MEMORIAL HOSPITAL OF BURLINGTON COUNTY, INC.
Entity Type:Organization
Organization Name:VIRTUA - MEMORIAL HOSPITAL OF BURLINGTON COUNTY, INC.
Other - Org Name:VIRTUA HOMECARE COMMUNITY NURSING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FOR FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:GERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-355-0604
Mailing Address - Street 1:523 FELLOWSHIP RD
Mailing Address - Street 2:STE 250
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-3414
Mailing Address - Country:US
Mailing Address - Phone:856-581-7200
Mailing Address - Fax:
Practice Address - Street 1:523 FELLOWSHIP RD
Practice Address - Street 2:STE 250
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-3414
Practice Address - Country:US
Practice Address - Phone:856-581-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ70304251E00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6880703Medicaid
317035Medicare Oscar/Certification