Provider Demographics
NPI:1083606164
Name:KENNEDY UNIVERSITY HOSPITAL, INC
Entity Type:Organization
Organization Name:KENNEDY UNIVERSITY HOSPITAL, INC
Other - Org Name:KENNEDY HOME HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:FLANNERY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:856-809-4331
Mailing Address - Street 1:333 LAUREL OAK ROAD
Mailing Address - Street 2:UNIT D
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043
Mailing Address - Country:US
Mailing Address - Phone:856-809-4300
Mailing Address - Fax:856-566-9455
Practice Address - Street 1:1099 WHITE HORSE RD
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4405
Practice Address - Country:US
Practice Address - Phone:856-566-2000
Practice Address - Fax:856-566-5288
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KENNEDY HOME HEALTH CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-16
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22365251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4146506Medicaid
4146514OtherCCPED MEDICAID
317073OtherRAILROAD MEDICARE
317073OtherHORIZON HMO
317073OtherHORIZON PPO BLUE SELECT
317073OtherHORIZON PPO BLUE CHOICE
2K1918OtherHEALTHNET
317073OtherMEDICARE PART B
317073OtherHORIZON MEDICARE POS
317073OtherHORIZON NJ PLUS
317073OtherHORIZON HMO BLUE
317073OtherCOMPSOURCE
317073OtherHORIZON POS
317073OtherHORIZON BLUE CARD PPO
317073OtherHORIZON HMO BLUE
317073OtherHORIZON HMO BLUE
=========OtherEMPIRE BLUE CROSS POS
317073Medicare ID - Type Unspecified