Provider Demographics
NPI:1255360954
Name:THE MILLHOUSE NURSING HOME
Entity type:Organization
Organization Name:THE MILLHOUSE NURSING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:TRAGER
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:609-394-3400
Mailing Address - Street 1:325 JERSEY ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08611-3113
Mailing Address - Country:US
Mailing Address - Phone:609-394-3400
Mailing Address - Fax:609-392-0163
Practice Address - Street 1:325 JERSEY ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08611-3113
Practice Address - Country:US
Practice Address - Phone:609-394-3400
Practice Address - Fax:609-392-0163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4483405Medicaid
NJ4483405Medicaid