Provider Demographics
NPI:1063556629
Name:MARCUS L. WARD HOME
Entity type:Organization
Organization Name:MARCUS L. WARD HOME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARRETT
Authorized Official - Middle Name:T
Authorized Official - Last Name:MIDGETT
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:732-430-3675
Mailing Address - Street 1:333 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-2491
Mailing Address - Country:US
Mailing Address - Phone:973-762-5050
Mailing Address - Fax:973-763-3155
Practice Address - Street 1:333 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-2491
Practice Address - Country:US
Practice Address - Phone:973-762-5050
Practice Address - Fax:973-763-3155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ30A000310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8025401Medicaid