1154429546 NPI number — CHRISTIAN HEALTH CARE CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154429546 NPI number — CHRISTIAN HEALTH CARE CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRISTIAN HEALTH CARE CENTER
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:
CHRISTIAN HEALTH CARE ADULT DAY CARE 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:
1154429546
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 SICOMAC AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WYCKOFF
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07481-2159
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-848-5200
Provider Business Mailing Address Fax Number:
201-848-5493

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 SIENA VLG
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAYNE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07470-3590
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-305-9155
Provider Business Practice Location Address Fax Number:
973-305-9730
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STAGG
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE VICE PRESIDENT CFO
Authorized Official Telephone Number:
201-848-5200

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X , with the licence number:  708111 , 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: 9103309 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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