Provider Demographics
NPI:1386054294
Name:VIRTUA HOME CARE -COMMUMITY NURSING SERVICES INC
Entity type:Organization
Organization Name:VIRTUA HOME CARE -COMMUMITY NURSING SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/EVP
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-355-0040
Mailing Address - Street 1:523 FELLOWSHIP RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-3414
Mailing Address - Country:US
Mailing Address - Phone:856-581-7214
Mailing Address - Fax:
Practice Address - Street 1:523 FELLOWSHIP RD
Practice Address - Street 2:SUITE 250
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-3414
Practice Address - Country:US
Practice Address - Phone:856-581-7214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIRTUA HEALTH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0107900251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8475300Medicaid