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Organization Active NPI

Virtua - Memorial Hospital Burlington County, Inc

Doing business as Memorial Hospital of Burlington County - Psychiatry Unit

  • Psychiatric Hospital Unit
  • Mount Holly, NJ
National Provider Identifier
1174529846
Registry record updated Apr 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
License
10301 Issued in NJ
Legal business name
VIRTUA - MEMORIAL HOSPITAL BURLINGTON COUNTY, INC
Doing business as
Memorial Hospital of Burlington County - Psychiatry Unit
Practice address
175 Madison Ave
Mount Holly, NJ 08060-2038
Phone
(609) 267-0700
NPI assigned
Jun 27, 2005
Last updated
Apr 15, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
VIRTUA HEALTH INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 15, 2025

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

Authorized official

Name
Mr. Gerry Lowe
Title
VP for Finance
Phone
(856) 355-0604

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X 10301 NJ Primary

Addresses

Primary practice location

175 Madison Ave
Mount Holly, NJ 08060-2038

Mailing address

406 Lippincott Dr Ste J
Attn: Christine Gordon
Marlton, NJ 08053-4168
Phone (856) 355-0655

Other identifiers 1

IdentifierTypeStateIssuer
4138929MedicaidNJ

Other names 1

  • Memorial Hospital of Burlington County - Psychiatry Unit Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120404000900 NJ Part A Provider - Hospital 4284541269 Practice locations: Mt. Holly, NJ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1174529846. Details of each certification follow.

Hospital certification: CCN 31S057

Legal name
VIRTUA - MEMORIAL HOSPITAL BURLINGTON COUNTY, INC.
Doing business as
VIRTUA MOUNT HOLLY HOSPITAL - PSYCHIATRIC UNIT
Organization structure
OtherNon-profit
Incorporated
Apr 16, 1880 in NJ
Enrollment address
175 Madison Avenue
Mt. Holly, NJ 80602038
Hospital Psychiatric Unit
Hospital subgroups
Psychiatric

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
OB GYN Mem Hosp Burling3 organizations share this tax ID, including this one
Part of
Virtua Health Inc

Other organizations with this tax ID 2

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

Member organizations 28

Organizations listed as members of this organization in the National Provider Directory.

View all 28

Locations

350 Young Ave
Ste 300
Moorestown, NJ 08057
Phone (856) 247-7330

401 Young Ave
Ste 145
Moorestown, NJ 08057
Phone (856) 291-8733

401 Young Ave
Ste 225
Moorestown, NJ 08057
Phone (856) 291-8990

523 Fellowship Rd
Ste 250
Mount Laurel, NJ 08054
Phone (856) 581-7200

101 Burrs Rd
Ste G
Westampton, NJ 08060
Phone (609) 261-4330

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Virtua Health , Inc Organization, Marlton, NJ Non-profit 5% Or Greater Direct Ownership Interest Dec 15, 1999
Richard Miller Individual Corporate OfficerPresident/Ceo Apr 28, 1986
W-2 Managing EmployeePresident/Ceo Apr 28, 1986
Robert Segin Individual Corporate OfficerCfo Feb 20, 1984
W-2 Managing EmployeeCfo Feb 20, 1984

Facilities with the same owner 7

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1119830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744675200000",
    "number": "1174529846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "406 LIPPINCOTT DR STE J",
            "address_2": "ATTN: CHRISTINE GORDON",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080534168",
            "telephone_number": "856-355-0655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 MADISON AVE",
            "city": "MOUNT HOLLY",
            "state": "NJ",
            "postal_code": "080602038",
            "telephone_number": "609-267-0700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIRTUA - MEMORIAL HOSPITAL BURLINGTON COUNTY, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VIRTUA HEALTH INC.",
        "enumeration_date": "2005-06-27",
        "last_updated": "2025-04-15",
        "certification_date": "2025-04-15",
        "status": "A",
        "authorized_official_last_name": "LOWE",
        "authorized_official_first_name": "GERRY",
        "authorized_official_title_or_position": "VP FOR FINANCE",
        "authorized_official_telephone_number": "856-355-0604",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "NJ",
            "license": "10301",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4138929",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Memorial Hospital of Burlington County - Psychiatry Unit",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Memorial Hospital of Burlington County - Psychiatry Unit",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Holly, NJ

Sources for this page

Verify at the official NPI Registry.