1215356910 NPI number — EVA'S VILLAGE, INC.

Table of content: (NPI 1215356910)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215356910 NPI number — EVA'S VILLAGE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EVA'S VILLAGE, INC.
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:
Provider Other Organization Name Type Code:
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:
1215356910
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
393 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PATERSON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07501-2815
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-523-6220
Provider Business Mailing Address Fax Number:
973-825-7297

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16 SPRING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PATERSON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07501-2823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-754-6780
Provider Business Practice Location Address Fax Number:
973-754-6794
Provider Enumeration Date:
04/09/2014

Additional Information

Authorized Official

Authorized Official Last Name:
SCHMIT
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
973-523-6220

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , with the licence number:  1000093 , 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: 7199708 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7632703 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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