1952397309 NPI number — SENIORCARE OF HAMILTON LLC

Table of content: (NPI 1952397309)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952397309 NPI number — SENIORCARE OF HAMILTON LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SENIORCARE OF HAMILTON LLC
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:
6
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:
1952397309
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1059 EDINBURG RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMILTON SQUARE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08690-1229
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-588-0091
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1059 EDINBURG RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMILTON SQUARE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08690-1229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-588-0091
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BOGDAN
Authorized Official First Name:
JOSEF
Authorized Official Middle Name:
Authorized Official Title or Position:
LNHA
Authorized Official Telephone Number:
609-588-0091

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  061111 , 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: 5212497 . This is a "AETNA (TRADITIONAL)" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 01000356300 . This is a "AMERICHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 315223 . This is a "HORIZON BC/BS (SKILLED)" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 8398208 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2499838 . This is a "AETNA (HMO)" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 001018 . This is a "HORIZON BC/BS (SUBACUTE)" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 97307 . This is a "AMERICAID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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