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General NPI Number Information
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NPI Number | 1679964712
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Entity Type | Organization
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Legal Business Name | SL MILLVILLE, LLC
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Dates
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Enumeration Date | 02/11/2015
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Last Update Date | 06/12/2015
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Provider Practice Location Address
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Address Line | 1719 W MAIN ST
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City | MILLVILLE
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State | NJ
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Zip | 08332-4632
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Country | US
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Telephone | 856-825-4002
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Fax | 856-327-2037
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Provider Business Mailing Address
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Address Line | 1719 W MAIN ST
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City | MILLVILLE
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State | NJ
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Zip | 08332-4632
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Country | US
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Telephone | 856-825-4002
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Fax | 856-327-2037
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | RITA RIVERA-WORLEY
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Credential |
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Telephone | 856-825-4002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 90108
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License Number State | NJ
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