1336619162 NPI number — ADVANCE DIVINE HEALTHCARE 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 1336619162 NPI number — ADVANCE DIVINE HEALTHCARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCE DIVINE HEALTHCARE 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:
1336619162
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1440 HOW LANE
Provider Second Line Business Mailing Address:
SUITE 2A
Provider Business Mailing Address City Name:
NORTH BRUNSWICK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-447-4085
Provider Business Mailing Address Fax Number:
732-418-1511

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1440 HOW LANE
Provider Second Line Business Practice Location Address:
SUITE 2A
Provider Business Practice Location Address City Name:
NORTH BRUNSWICK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-447-4085
Provider Business Practice Location Address Fax Number:
732-418-1511
Provider Enumeration Date:
12/05/2018

Additional Information

Authorized Official

Authorized Official Last Name:
OHALE
Authorized Official First Name:
CELESTINE
Authorized Official Middle Name:
U
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
732-447-4085

Provider Taxonomy Codes

  • Taxonomy code: 320900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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