1861509408 NPI number — HAMMONTON RESCUE SQUAD INC

Table of content: (NPI 1861509408)

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".