1063483501 NPI number — VISITING NURSE ASSOCIATION OF SAINT CLARE'S, INC.

Table of content: (NPI 1063483501)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063483501 NPI number — VISITING NURSE ASSOCIATION OF SAINT CLARE'S, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VISITING NURSE ASSOCIATION OF SAINT CLARE'S, 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:
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:
1063483501
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
191 WOODPORT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPARTA
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07871-2641
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-729-7078
Provider Business Mailing Address Fax Number:
973-729-7057

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
191 WOODPORT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPARTA
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07871-2641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-729-7078
Provider Business Practice Location Address Fax Number:
973-729-7057
Provider Enumeration Date:
02/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HAMMOND
Authorized Official First Name:
FRED
Authorized Official Middle Name:
Authorized Official Title or Position:
ORGANIZATIONAL CFO
Authorized Official Telephone Number:
973-729-7078

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  71902 , 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: 242176 . This is a "LIBERTY MUTUAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 33550 . This is a "AMERI-GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: OLO538 . This is a "HEALTH NET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 011086 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1033739 . This is a "HORIZON NJ HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 120635 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 317076 . This is a "BCBS OF NEW JERSEY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 35182 . This is a "CORE SOURCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: A437744C . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 139989 . This is a "GENTIVA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4222 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3692400 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3692418 . This is a "PCA/CCPED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 78010000317076 . This is a "FEDERAL HORIZON" identifier . This identifiers is of the category "OTHER".




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