Provider Demographics
NPI:1306275805
Name:PRAM MOUNT VERNON TE LLC
Entity type:Organization
Organization Name:PRAM MOUNT VERNON TE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:VELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-582-0400
Mailing Address - Street 1:515 PLAINFIELD AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-2598
Mailing Address - Country:US
Mailing Address - Phone:732-582-0400
Mailing Address - Fax:908-378-1690
Practice Address - Street 1:3709 SHANNONS GREEN WAY
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22309-3659
Practice Address - Country:US
Practice Address - Phone:703-780-7100
Practice Address - Fax:703-780-5771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAALF 1104029-L152310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility