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NPI Code Detail

MEDICARE: SEACREST VILLAGE, INC

MEDICARE: SEACREST VILLAGE, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing FacilityNJ61522NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1144217662
Entity Type Code : Organization
Provider Name (Legal Business Name) : SEACREST VILLAGE, INC
Provider Business Mailing Address
First Line : 1001 CENTER ST
Second Line : PO BOX 1480
City : LITTLE EGG HARBOR TWP
State : NJ
Zip : 08087-1347
Country : US
Telephone Number : 609-296-9292
Fax Number : 609-296-0508
Provider Business Practice Location Address
First Line : 1001 CENTER ST
Second Line :
City : LITTLE EGG HARBOR TWP
State : NJ
Zip : 08087-1347
Country : US
Telephone Number : 609-296-9292
Fax Number : 609-296-0508
Authorized Official
Title or Position : PRESIDENT
Name : MR. BRIAN T. HOLLOWAY
Credential :
Telephone Number : 609-296-9292
Provider Enumeration Date : 09/30/2005
Last Update Date : 08/22/2020

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Directions to “SEACREST VILLAGE, INC ” Practice Location

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