Provider Demographics
NPI:1386434389
Name:NOVA GRATIA HEALTHCARE SERVICES
Entity type:Organization
Organization Name:NOVA GRATIA HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:OLANIRAN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:ODEYEMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-602-5760
Mailing Address - Street 1:1321 SASSAFRAS LN
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-3867
Mailing Address - Country:US
Mailing Address - Phone:856-602-5760
Mailing Address - Fax:
Practice Address - Street 1:1321 SASSAFRAS LN
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08094-3867
Practice Address - Country:US
Practice Address - Phone:856-602-5760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care