Provider Demographics
NPI:1013982719
Name:CITY OF VINELAND-HEALTH
Entity Type:Organization
Organization Name:CITY OF VINELAND-HEALTH
Other - Org Name:COMMUNITY NURSING SERVICE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MAYOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:ROMEO
Authorized Official - Last Name:FANUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-794-4000
Mailing Address - Street 1:640 E. WOOD STREET
Mailing Address - Street 2:PO BOX 1508
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-1508
Mailing Address - Country:US
Mailing Address - Phone:856-794-4000
Mailing Address - Fax:856-405-4608
Practice Address - Street 1:610 MONTROSE STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-1508
Practice Address - Country:US
Practice Address - Phone:856-794-4000
Practice Address - Fax:856-692-1872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-17
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ70601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3690504Medicaid
NJ317051Medicare ID - Type UnspecifiedHOME HEALTH AGENCY
NJ3690504Medicaid