1588844195 NPI number — ADDUS HEALTHCARE (NEW JERSEY), INC

Table of content: (NPI 1588844195)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588844195 NPI number — ADDUS HEALTHCARE (NEW JERSEY), INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADDUS HEALTHCARE (NEW JERSEY), INC
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:
Provider Other Organization Name Type Code:
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:
1588844195
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17 JAMES ST
Provider Second Line Business Mailing Address:
UNIT 6A
Provider Business Mailing Address City Name:
BLOOMFIELD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07003-3656
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-743-4200
Provider Business Mailing Address Fax Number:
973-742-4220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17 JAMES ST
Provider Second Line Business Practice Location Address:
UNIT 6A
Provider Business Practice Location Address City Name:
BLOOMFIELD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07003-3656
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-743-4200
Provider Business Practice Location Address Fax Number:
973-742-4220
Provider Enumeration Date:
11/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KUMARICH
Authorized Official First Name:
DIANE
Authorized Official Middle Name:
Authorized Official Title or Position:
NATIONAL CONTRACTS
Authorized Official Telephone Number:
847-303-5300

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HP0097800 , 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)





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