Provider Demographics
NPI:1720107683
Name:SALEM COUNTY OFFICE ON AGING
Entity Type:Organization
Organization Name:SALEM COUNTY OFFICE ON AGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARE COORDINATOR SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:JUNE
Authorized Official - Last Name:MARKS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:856-339-8622
Mailing Address - Street 1:98 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NJ
Mailing Address - Zip Code:08079-1912
Mailing Address - Country:US
Mailing Address - Phone:856-339-8622
Mailing Address - Fax:856-339-9268
Practice Address - Street 1:98 MARKET ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NJ
Practice Address - Zip Code:08079-1912
Practice Address - Country:US
Practice Address - Phone:856-339-8622
Practice Address - Fax:856-339-9268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8150613Medicaid