Basic Information
| Provider Information | |||||||||
| NPI: | 1578555140 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VIRTUA HEALTH & REHABILITATION CENTER AT BERLIN, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | VIRTUA HEALTH AND REHABILITATION CENTER AT BERLIN INC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 W. STOW RD. | ||||||||
| Address2: | STE 8 | ||||||||
| City: | MARLTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563550655 | ||||||||
| FaxNumber: | 8563550621 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 LONG A COMING LN | ||||||||
| Address2: | |||||||||
| City: | BERLIN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080091964 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563223684 | ||||||||
| FaxNumber: | 8563223601 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2005 | ||||||||
| LastUpdateDate: | 04/11/2019 | ||||||||
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| AuthorizedOfficialLastName: | PULLIN | ||||||||
| AuthorizedOfficialFirstName: | DENNIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 8563550004 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | VIRTUA HEALTH INC. | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 156001 | NJ | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 8121702 | 05 | NJ | MEDICAID |