Provider Demographics
NPI:1104964550
Name:VISITING NURSE ASSOCIATION OF CENTRAL JERSEY COMMUNITY HEALTH CENTER I
Entity type:Organization
Organization Name:VISITING NURSE ASSOCIATION OF CENTRAL JERSEY COMMUNITY HEALTH CENTER I
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:S
Authorized Official - Last Name:LININGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-502-5151
Mailing Address - Street 1:1301 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ASBURY PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07712
Mailing Address - Country:US
Mailing Address - Phone:732-774-6333
Mailing Address - Fax:732-774-0313
Practice Address - Street 1:100 MAIN STREET
Practice Address - Street 2:
Practice Address - City:KEANSBURG
Practice Address - State:NJ
Practice Address - Zip Code:07734
Practice Address - Country:US
Practice Address - Phone:732-787-1250
Practice Address - Fax:732-787-4079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QF0400X
NJ261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0119148Medicaid
NJ311876Medicare Oscar/Certification