=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710929997
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MILLVILLE MERIDIAN, LP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2006
-----------------------------------------------------
Last Update Date | 11/14/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 54 SHARP ST
-----------------------------------------------------
City | MILLVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08332-2444
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-327-2700
-----------------------------------------------------
Fax | 856-276-6796
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 E STATE ST
-----------------------------------------------------
City | KENNETT SQUARE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19348-3109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-925-4436
-----------------------------------------------------
Fax | 610-925-4351
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CORPORATE MANAGER
-----------------------------------------------------
Name | JANE DROPESKEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 610-925-4231
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 060608
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------