Provider Demographics
NPI:1649677824
Name:REFORMED CHURCH MINISTRIES TO THE AGING, THE PARTICULAR SYNOD OF THE M
Entity type:Organization
Organization Name:REFORMED CHURCH MINISTRIES TO THE AGING, THE PARTICULAR SYNOD OF THE M
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPARD
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, LNHA
Authorized Official - Phone:732-607-9230
Mailing Address - Street 1:1990 ROUTE 18 N
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-3771
Mailing Address - Country:US
Mailing Address - Phone:732-607-9230
Mailing Address - Fax:
Practice Address - Street 1:1990 ROUTE 18 N
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-3771
Practice Address - Country:US
Practice Address - Phone:732-607-9230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-03
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ50A002310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0131636Medicaid