1952395030 NPI number — KENNEDY HEALTH FACILITIES, INC.

Table of content: (NPI 1952395030)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952395030 NPI number — KENNEDY HEALTH FACILITIES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KENNEDY HEALTH FACILITIES, 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:
1952395030
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
535 EGG HARBOR RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEWELL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08080-2335
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-582-3170
Provider Business Mailing Address Fax Number:
856-582-3143

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
535 EGG HARBOR RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEWELL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08080-2335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-582-3170
Provider Business Practice Location Address Fax Number:
856-582-3143
Provider Enumeration Date:
09/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KOSS
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT, AMBULATORY SERVICES
Authorized Official Telephone Number:
856-566-5279

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  060806 , 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: 315231 . This is a "HORIZON BLUE CROSS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 612914300 . This is a "FEDERAL BLACK LUNG" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 13145 . This is a "AETNA USHEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 4478304 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000591100 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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