Provider Demographics
NPI:1699712166
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:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SCHEDULING & CREDENTIALING
Authorized Official - Prefix:MS
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-502-5144
Mailing Address - Street 1:806 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:ASBURY PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-5363
Mailing Address - Country:US
Mailing Address - Phone:732-502-5144
Mailing Address - Fax:732-264-0799
Practice Address - Street 1:64-66 BRIDGE AVENUE
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701
Practice Address - Country:US
Practice Address - Phone:732-219-6620
Practice Address - Fax:732-219-6625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ23983261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0119130Medicaid
NJ311865Medicare Oscar/Certification
NJ006407Medicare ID - Type UnspecifiedMEDICARE B