Healthcare Provider Details

I. General information

NPI: 1518203462
Provider Name (Legal Business Name): ST. JOHN OF GOD COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2012
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1147 DELSEA DRIVE
WESTVILLE GROVE NJ
08093
US

IV. Provider business mailing address

1147 DELSEA DRIVE
WESTVILLE GROVE NJ
08093
US

V. Phone/Fax

Practice location:
  • Phone: 856-848-4700
  • Fax: 856-384-1512
Mailing address:
  • Phone: 856-848-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNJ

VIII. Authorized Official

Name: THOMAS OSORIO
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 856-848-4700