Provider Demographics
NPI:1740319508
Name:CHRILL VISITING NURSE ASSOCIATION
Entity type:Organization
Organization Name:CHRILL VISITING NURSE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:TIPALDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-509-9870
Mailing Address - Street 1:60 S FULLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2632
Mailing Address - Country:US
Mailing Address - Phone:973-509-9870
Mailing Address - Fax:973-746-9629
Practice Address - Street 1:60 S FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2632
Practice Address - Country:US
Practice Address - Phone:973-509-9870
Practice Address - Fax:973-746-9629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1097906OtherHORIZON NJ HEALTH
NJ2391858OtherAETNA
NJ7651902Medicaid
NJ317009Medicare ID - Type Unspecified