NPIMap

Organization Active NPI

Virtua Willingboro Hospital, Inc.

Doing business as Virtua Willingboro Hospital - Psych

  • Psychiatric Hospital Unit
  • Willingboro, NJ
National Provider Identifier
1285630087
Registry record updated Apr 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
License
10303 Issued in NJ
Legal business name
VIRTUA WILLINGBORO HOSPITAL, INC.
Doing business as
Virtua Willingboro Hospital - Psych
Practice address
218A Sunset Road
Willingboro, NJ 08046-1110
Phone
(609) 835-2900
Fax
(609) 835-3061
NPI assigned
Jun 27, 2005
Last updated
Apr 15, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
OUR LADY OF LOURDES HEALTH CARE SERVICES.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
John Kirby
Title
President
Phone
(609) 914-6202

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X 10303 NJ Primary

Addresses

Primary practice location

218A Sunset Road
Willingboro, NJ 08046-1110

Mailing address

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

Other names 1

  • Virtua Willingboro Hospital - Psych Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210524002833 NJ Part A Provider - Hospital 2668380866 Practice locations: Willingboro, NJ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1285630087. Details of each certification follow.

Hospital certification: CCN 31S061

Legal name
VIRTUA WILLINGBORO HOSPITAL INC
Doing business as
VIRTUA WILLINGBORO HOSPITAL - PSYCH
Organization structure
OtherNon-profit
Enrollment address
218A Sunset Rd
Willingboro, NJ 80461110
Hospital Psychiatric Unit
Hospital subgroups
Psychiatric unit

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

Locations

828 Jersey Ave
Gloucester City, NJ 08030
Phone (856) 349-2458

20 W Stow Rd
Ste 8
Marlton, NJ 08053

350 Young Ave
Ste 400
Moorestown, NJ 08057
Phone (888) 847-8823

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Dennis W Pullin Individual Corporate OfficerCeo, Virtua Jul 1, 2019
Virtua Health , Inc Organization, Marlton, NJ Corporation, Non-profit, Chain home office 5% Or Greater Indirect Ownership Interest Jul 1, 2019 100%
Operational/Managerial Control Jul 1, 2019 100%
Robert Segin Individual Corporate OfficerCfo/Evp, Virtual Health Inc Jul 1, 2019
Mark Nessel Individual Corporate OfficerSVP and Coo Lourdes Jul 1, 2019
W-2 Managing EmployeeSVP and Coo Lourdes Jul 1, 2019
Operational/Managerial ControlSVP and Coo Lourdes Jul 1, 2019
Our Lady of Lourdes Health Care Services, Inc Organization, Camden, NJ Corporation, Non-profit 5% Or Greater Direct Ownership Interest Dec 3, 1998 100%

Facilities with the same owner 7

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

Practitioners & affiliated clinicians

Practitioners 4

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.

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": "1285630087",
    "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",
            "fax_number": "856-355-0621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "218A SUNSET ROAD",
            "city": "WILLINGBORO",
            "state": "NJ",
            "postal_code": "080461110",
            "telephone_number": "609-835-2900",
            "fax_number": "609-835-3061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIRTUA WILLINGBORO HOSPITAL, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OUR LADY OF LOURDES HEALTH CARE SERVICES.INC.",
        "enumeration_date": "2005-06-27",
        "last_updated": "2025-04-15",
        "certification_date": "2025-04-15",
        "status": "A",
        "authorized_official_last_name": "KIRBY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "609-914-6202"
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "NJ",
            "license": "10303",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Virtua Willingboro Hospital - Psych",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Willingboro, NJ

Sources for this page

Verify at the official NPI Registry.