1861509408 NPI number — HAMMONTON RESCUE SQUAD INC

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 1861509408 NPI number — HAMMONTON RESCUE SQUAD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAMMONTON RESCUE SQUAD 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:
1861509408
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:
PO BOX 604
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMMONTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08037-0604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-561-0220
Provider Business Mailing Address Fax Number:
609-561-2158

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 S EGG HARBOR ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMMONTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08037-1416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-561-0220
Provider Business Practice Location Address Fax Number:
609-561-2158
Provider Enumeration Date:
08/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KACZMARSKI
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
L
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
609-561-0220

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  HAMM00247 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 343900000X , with the licence number: HAMM00247 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 28954 . This is a "UNIVERSITY HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 33480 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0500521000 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0973009 . This is a "AETNA USHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 32798 . This is a "AMERIGROUP NEW JERSEY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7420404 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1077588 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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