Provider Demographics
NPI:1386746592
Name:KENNEDY UNIVERSITY HOSPITAL INC.
Entity type:Organization
Organization Name:KENNEDY UNIVERSITY HOSPITAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL CFO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MACCRACKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-481-2853
Mailing Address - Street 1:PO BOX 787032
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-7032
Mailing Address - Country:US
Mailing Address - Phone:856-661-5164
Mailing Address - Fax:856-661-5274
Practice Address - Street 1:18 E LAUREL RD
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:NJ
Practice Address - Zip Code:08084-1327
Practice Address - Country:US
Practice Address - Phone:856-346-6000
Practice Address - Fax:856-346-6005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ10403261QE0002X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4140206Medicaid
NJ4140206Medicaid