Provider Demographics
NPI:1396311460
Name:MILFORD WELLNESS VILLAGE PACE LLC
Entity type:Organization
Organization Name:MILFORD WELLNESS VILLAGE PACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MEIR
Authorized Official - Middle Name:
Authorized Official - Last Name:GELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-262-2255
Mailing Address - Street 1:260 CHAMBERS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-2809
Mailing Address - Country:US
Mailing Address - Phone:732-262-2255
Mailing Address - Fax:732-262-3332
Practice Address - Street 1:21 W CLARKE AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-1849
Practice Address - Country:US
Practice Address - Phone:732-262-2255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-31
Last Update Date:2021-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization