Provider Demographics
NPI:1114715877
Name:THE RACQUET CLUB OF WARREN, INC
Entity type:Organization
Organization Name:THE RACQUET CLUB OF WARREN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:KERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-647-0400
Mailing Address - Street 1:149 MOUNT BETHEL RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-5154
Mailing Address - Country:US
Mailing Address - Phone:908-647-0400
Mailing Address - Fax:
Practice Address - Street 1:149 MOUNT BETHEL RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-5154
Practice Address - Country:US
Practice Address - Phone:908-647-0400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service