Provider Demographics
NPI:1194715409
Name:NEW JERSEY VETERANS MEMORIAL HOME MENLO PARK
Entity type:Organization
Organization Name:NEW JERSEY VETERANS MEMORIAL HOME MENLO PARK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CAUSER
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA, CMDCP
Authorized Official - Phone:732-452-4102
Mailing Address - Street 1:132 EVERGREEN RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-2484
Mailing Address - Country:US
Mailing Address - Phone:732-452-4167
Mailing Address - Fax:732-603-3016
Practice Address - Street 1:132 EVERGREEN RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-2484
Practice Address - Country:US
Practice Address - Phone:732-452-4167
Practice Address - Fax:732-603-3016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
870585Medicare PIN
NJ171142Medicare PIN
NJ315459Medicare ID - Type UnspecifiedPROVIDER NUMBER