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General NPI Number Information
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NPI Number | 1245445584
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Entity Type | Organization
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Legal Business Name | MERCER CTY OFFICE AGING
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 07/16/2008
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Provider Practice Location Address
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Address Line | 200 WOOLVERTON ST.
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City | TRENTON
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State | NJ
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Zip | 08650
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Country | US
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Telephone | 609-989-6661
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Fax | 609-989-9337
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Provider Business Mailing Address
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Address Line | 640 S. BROAD ST. BOX 8068
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City | TRENTON
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State | NJ
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Zip | 08650-0068
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Country | US
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Telephone | 609-989-6662
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Fax | 609-989-9337
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. EILEEN DOREMUS
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Credential | BA, CSW
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Telephone | 609-989-6662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 8185913
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 8185905
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License Number State | NJ
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