Provider Demographics
NPI:1245445584
Name:MERCER CTY OFFICE AGING
Entity type:Organization
Organization Name:MERCER CTY OFFICE AGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOREMUS
Authorized Official - Suffix:
Authorized Official - Credentials:BA, CSW
Authorized Official - Phone:609-989-6662
Mailing Address - Street 1:640 S. BROAD ST.
Mailing Address - Street 2:BOX 8068
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08650-0068
Mailing Address - Country:US
Mailing Address - Phone:609-989-6662
Mailing Address - Fax:609-989-9337
Practice Address - Street 1:200 WOOLVERTON ST.
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08650
Practice Address - Country:US
Practice Address - Phone:609-989-6661
Practice Address - Fax:609-989-9337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ8185913171M00000X
NJ8185905171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8185905Medicaid
NJ8185913Medicaid