Provider Demographics
NPI:1316070477
Name:COUNTY OF GLOUCESTER, DEPT OF SENIOR SERVICES
Entity type:Organization
Organization Name:COUNTY OF GLOUCESTER, DEPT OF SENIOR SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNTY TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUBOIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-853-3353
Mailing Address - Street 1:1 N BROAD ST
Mailing Address - Street 2:PO BOX 337
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-4602
Mailing Address - Country:US
Mailing Address - Phone:856-853-3353
Mailing Address - Fax:856-845-6234
Practice Address - Street 1:211 COUNTY HOUSE RD
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2525
Practice Address - Country:US
Practice Address - Phone:856-232-4646
Practice Address - Fax:856-232-6709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8150702Medicaid
NJ0110639Medicaid