1104141258 NPI number — CATHOLIC CHARITIES OF THE ARCHDIOCESE OF NEWARK

Table of content: (NPI 1104141258)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104141258 NPI number — CATHOLIC CHARITIES OF THE ARCHDIOCESE OF NEWARK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CATHOLIC CHARITIES OF THE ARCHDIOCESE OF NEWARK
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:
CATHOLIC CHARITIES MOBILE RESPONSE
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:
1104141258
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
590 N 7TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07107-2522
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-266-7998
Provider Business Mailing Address Fax Number:
973-596-4030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3040 KENNEDY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JERSEY CITY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07306-3604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-798-7452
Provider Business Practice Location Address Fax Number:
973-596-4030
Provider Enumeration Date:
04/01/2010

Additional Information

Authorized Official

Authorized Official Last Name:
DAUL
Authorized Official First Name:
ALLEN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
973-266-7998

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0023574 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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