Healthcare Provider Details

I. General information

NPI: 1780688226
Provider Name (Legal Business Name): REFORMED CHURCH MINISTRIES TO THE AGING, THE PARTICULAR SYNOD OF THE M
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 06/03/2024
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 ROUTE 18
OLD BRIDGE NJ
08857-3771
US

IV. Provider business mailing address

1990 ROUTE 18
OLD BRIDGE NJ
08857-3771
US

V. Phone/Fax

Practice location:
  • Phone: 732-607-9230
  • Fax:
Mailing address:
  • Phone: 732-607-9230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number030709
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number50A002
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0131636
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer
# 2
Identifier4477502
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: RUBY ANASTOS
Title or Position: CONTROLLER
Credential: CPA
Phone: 732-607-9230