MEDICARE: VINELAND OPERATIONS, LLC

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
1	314000000X	Skilled Nursing Facility	060607	NJ

Other Identifiers

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

General Provider Information

NPI Number	:	1366484792
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VINELAND OPERATIONS, LLC

Provider Business Mailing Address
First Line	:	170 53RD ST
Second Line	:	3RD FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11232-4319
Country	:	US
Telephone Number	:	718-567-0400
Fax Number	:	718-567-0600

Provider Business Practice Location Address
First Line	:	1640 S LINCOLN AVE
Second Line	:
City	:	VINELAND
State	:	NJ
Zip	:	08361-6610
Country	:	US
Telephone Number	:	856-692-8080
Fax Number	:	856-692-0448

Authorized Official
Title or Position	:	COMPTROLLER
Name	:	MR. SAM STERN
Credential	:
Telephone Number	:	718-567-0400

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	08/22/2020

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Directions to “VINELAND OPERATIONS, LLC ” Practice Location

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