NPIMap

Organization Active NPI

Wiley Mission

  • Skilled Nursing Facility
  • Marlton, NJ
National Provider Identifier
1023009156
Registry record updated Aug 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
030307 Issued in NJ
Legal business name
WILEY MISSION
Practice address
99 E Main St
Marlton, NJ 08053-2122
Phone
(856) 983-0411
Fax
(856) 985-4655
NPI assigned
Oct 28, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Victor A Flamini
Title
Cfo
Phone
(856) 983-0411

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Custodial Care Facility 311Z00000X 153335 NJ
Skilled Nursing Facility 314000000X 030307 NJ Primary

Addresses

Primary practice location

99 E Main St
Marlton, NJ 08053-2122

Mailing address

99 E Main St
Marlton, NJ 08053-2122
Phone (856) 983-0411

Other identifiers 1

IdentifierTypeStateIssuer
4466900MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120423000208 NJ Part A Provider - Skilled Nursing Facility 3375637176 Practice locations: Marlton, NJ

Skilled nursing facility certification: CCN 315418

Legal name
WILEY MISSION
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Dec 5, 1997
Last certification
Sep 27, 2024
Beds
86
Ownership / control type
Church Related
Organization structure
CorporationNon-profit
Incorporated
Oct 21, 1943 in NJ
Enrollment address
99E Main St
Marlton, NJ 08053-2122
Nursing home name
WILEY MISSION

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
Wiley MissionCCN 315418
Overall star rating
4 of 5
Health inspections
3 of 5
Staffing
5 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Church related
Certified
Dec 5, 1997
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
8667.3 residents per day on average

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Wiley Mission2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 7

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Carol J Otte Individual Managing Control - Governing BodyBoard Chair May 1, 2006
Trustee of the SNF May 1, 2006
Individual Adp of the SNF Jan 1, 2012
Gary Glimore Individual Corporate OfficerPresident/Ceo Jun 1, 1986
Operational/Managerial Control Jun 1, 1986
Managing Control - Governing BodyPresident/Ceo Jun 1, 1986
Adp of the SNF Jan 1, 1986
Victor Flamini Individual Corporate OfficerBoard Secretary & Cfo May 1, 2006
Operational/Managerial Control May 1, 2006
Managing Control - Governing BodySecretary May 1, 2006
Trustee of the SNF May 1, 2006
Adp of the SNF May 1, 2006
Jay Farquhar Individual Managing Control - Governing BodyVice-Chair/Treasurer Jan 1, 2017
Trustee of the SNF Jan 1, 2017
Thomas Hall Individual Managing Control - Governing BodyBoard Member May 1, 2014
Trustee of the SNF May 1, 2014
John Douglas Glimore Individual Managing Control - Governing BodyBoard Member May 1, 1987
Trustee of the SNF May 1, 1987

Practitioners & affiliated clinicians

Affiliated clinicians 7

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723766400000",
    "number": "1023009156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "99 E MAIN ST",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080532122",
            "telephone_number": "856-983-0411",
            "fax_number": "856-985-4655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "99 E MAIN ST",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080532122",
            "telephone_number": "856-983-0411",
            "fax_number": "856-985-4655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILEY MISSION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-28",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-16",
        "status": "A",
        "authorized_official_last_name": "FLAMINI",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "856-983-0411"
    },
    "taxonomies": [
        {
            "code": "311Z00000X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility",
            "state": "NJ",
            "license": "153335",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NJ",
            "license": "030307",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4466900",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marlton, NJ

Sources for this page

Verify at the official NPI Registry.