Healthcare Provider Details

I. General information

NPI: 1114991437
Provider Name (Legal Business Name): JOB HAINES HOME FOR AGED PEOPLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BLOOMFIELD AVE
BLOOMFIELD NJ
07003-5689
US

IV. Provider business mailing address

250 BLOOMFIELD AVENUE
BLOOMFIELD NJ
07003
US

V. Phone/Fax

Practice location:
  • Phone: 973-743-0792
  • Fax:
Mailing address:
  • Phone: 973-743-0792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number030706
License Number StateNJ

VIII. Authorized Official

Name: MS. NOREEN ELIZABETH HAVERON
Title or Position: PRESIDENT EXECUTIVE DIRECTOR
Credential: LNHA MPA
Phone: 973-743-0792