Healthcare Provider Details

I. General information

NPI: 1174520076
Provider Name (Legal Business Name): VNA HEALTH GROUP OF NEW JERSEY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 MAIN STREET - SUITE 300
WEST ORANGE NJ
07052-4850
US

IV. Provider business mailing address

23 MAIN STREET SUITE D1
HOLMDEL NJ
07733-2136
US

V. Phone/Fax

Practice location:
  • Phone: 973-243-9666
  • Fax: 732-784-9901
Mailing address:
  • Phone: 732-224-6914
  • Fax: 732-784-9710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number22714,24416,22634
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number24416
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number22634
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number22714
License Number StateNJ

VIII. Authorized Official

Name: MR. PETER GAYLORD
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 800-862-3330