1912015223 NPI number — WAYNE VIEW CORP

Table of content: (NPI 1912015223)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912015223 NPI number — WAYNE VIEW CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WAYNE VIEW CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ATRIUM POST ACUTE CARE OF WAYNE VIEW
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912015223
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2029 MORRIS AVE
Provider Second Line Business Mailing Address:
SUITE # 2
Provider Business Mailing Address City Name:
UNION
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07083-6013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-686-3233
Provider Business Mailing Address Fax Number:
908-686-3668

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2020 ROUTE 23 NORTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAYNE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07470
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-305-8400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LINTEAU
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
B
Authorized Official Title or Position:
CONTRACT MANAGER
Authorized Official Telephone Number:
908-686-3233

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  061629 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4495802 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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