1528052412 NPI number — HEBREW OLD AGE CENTER OF ATLANTIC CITY

Table of content: (NPI 1528052412)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528052412 NPI number — HEBREW OLD AGE CENTER OF ATLANTIC CITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEBREW OLD AGE CENTER OF ATLANTIC CITY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SEASHORE GARDENS LIVING CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528052412
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22 W JIMMIE LEEDS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GALLOWAY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08205-9422
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-404-4848
Provider Business Mailing Address Fax Number:
609-404-4841

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 W JIMMIE LEEDS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GALLOWAY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08205-9422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-404-4848
Provider Business Practice Location Address Fax Number:
609-404-4841
Provider Enumeration Date:
09/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CAMBRON
Authorized Official First Name:
JANICE
Authorized Official Middle Name:
T
Authorized Official Title or Position:
ASSISTANT EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
609-404-4848

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  O/A 006 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: 030102 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4463111 . This is a "AL" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 4463102 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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