Healthcare Provider Details

I. General information

NPI: 1104965086
Provider Name (Legal Business Name): SISTERS OF CHARITY OF ST ELIZABETH- ST ANNE VILLA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 PARK AVE
FLORHAM PARK NJ
07932-1049
US

IV. Provider business mailing address

PO BOX 476
CONVENT STATION NJ
07961-0476
US

V. Phone/Fax

Practice location:
  • Phone: 973-867-1502
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNJ 60920
License Number StateNJ

VIII. Authorized Official

Name: MARION FARRELL
Title or Position: ADMINISTRATOR
Credential: LNHA
Phone: 973-867-1502