Provider Demographics
NPI:1154429546
Name:CHRISTIAN HEALTH CARE CENTER
Entity type:Organization
Organization Name:CHRISTIAN HEALTH CARE CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:STAGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-848-5200
Mailing Address - Street 1:301 SICOMAC AVE
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-2159
Mailing Address - Country:US
Mailing Address - Phone:201-848-5200
Mailing Address - Fax:201-848-5493
Practice Address - Street 1:2000 SIENA VLG
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-3590
Practice Address - Country:US
Practice Address - Phone:973-305-9155
Practice Address - Fax:973-305-9730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ708111261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9103309Medicaid
NJ9103309Medicaid