Provider Demographics
NPI:1972605004
Name:KENNEDY UNIVERSITY HOSPITAL INC.
Entity type:Organization
Organization Name:KENNEDY UNIVERSITY HOSPITAL INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:LARIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-661-5144
Mailing Address - Street 1:PO BOX 13703
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19101-3703
Mailing Address - Country:US
Mailing Address - Phone:856-661-5164
Mailing Address - Fax:856-661-5274
Practice Address - Street 1:201 LAUREL OAK RD
Practice Address - Street 2:SUITE A
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4424
Practice Address - Country:US
Practice Address - Phone:856-566-6123
Practice Address - Fax:856-566-9432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1077261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5087601Medicaid
NJ5087601Medicaid