Healthcare Provider Details

I. General information

NPI: 1548244627
Provider Name (Legal Business Name): SALEM COUNTY NURSING HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 WOODSTOWN RD.
SALEM NJ
08079
US

IV. Provider business mailing address

438 WOODSTOWN RD.
SALEM NJ
08079
US

V. Phone/Fax

Practice location:
  • Phone: 856-395-6677
  • Fax:
Mailing address:
  • Phone: 856-395-6677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number061703
License Number StateNJ

VIII. Authorized Official

Name: DOUGLAS POWNALL
Title or Position: ADMINISTRATOR
Credential:
Phone: 856-395-6677