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General NPI Number Information
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NPI Number | 1144714080
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Entity Type | Organization
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Legal Business Name | VILLAGE DRIVE HEALTHCARE URBAN RENEWAL LLC
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Dates
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Enumeration Date | 06/14/2018
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Last Update Date | 12/29/2022
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Provider Practice Location Address
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Address Line | 1125 VILLAGE DR
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City | MILLVILLE
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State | NJ
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Zip | 08332-1581
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Country | US
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Telephone | 732-403-3151
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Fax |
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Provider Business Mailing Address
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Address Line | 1125 VILLAGE DR
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City | MILLVILLE
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State | NJ
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Zip | 08332-1513
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Country | US
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Telephone | 856-469-8192
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DREW BARILE
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Credential |
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Telephone | 732-403-3151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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