Provider Demographics
NPI:1063725281
Name:SOUTH JERSEY SPECIALTY HOSPITAL, INC.
Entity type:Organization
Organization Name:SOUTH JERSEY SPECIALTY HOSPITAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:CASSADY
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:707-887-7281
Mailing Address - Street 1:10200 MALLARD CREEK RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-9704
Mailing Address - Country:US
Mailing Address - Phone:609-835-3650
Mailing Address - Fax:609-835-5784
Practice Address - Street 1:1925 PACIFIC AVE
Practice Address - Street 2:5TH FLOOR
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-6713
Practice Address - Country:US
Practice Address - Phone:609-835-3650
Practice Address - Fax:609-835-5784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ312023Medicare Oscar/Certification