Provider Demographics
NPI:1699984930
Name:INDEPENDENCE MANOR AT HUNTERDON INC
Entity type:Organization
Organization Name:INDEPENDENCE MANOR AT HUNTERDON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:P
Authorized Official - Last Name:NAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-788-4893
Mailing Address - Street 1:188 ROUTE 31
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-5735
Mailing Address - Country:US
Mailing Address - Phone:908-788-4893
Mailing Address - Fax:908-788-3783
Practice Address - Street 1:188 ROUTE 31
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-5735
Practice Address - Country:US
Practice Address - Phone:908-788-4893
Practice Address - Fax:908-788-3783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ45A000310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8210501Medicaid