Healthcare Provider Details

I. General information

NPI: 1275524746
Provider Name (Legal Business Name): HOME FOR THE ARMENIAN AGED INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 03/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 MAIN ST
EMERSON NJ
07630-1948
US

IV. Provider business mailing address

70 MAIN ST
EMERSON NJ
07630-1948
US

V. Phone/Fax

Practice location:
  • Phone: 201-261-6662
  • Fax: 201-261-5509
Mailing address:
  • Phone: 201-261-6662
  • Fax: 201-261-5509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number030202
License Number StateNJ

VIII. Authorized Official

Name: MR. MATTHEW RUSSO
Title or Position: ADMINISTRATOR
Credential: LNHA
Phone: 201-261-6662