Provider Demographics
NPI:1235390568
Name:TAKE CARE HEALTH NEW JERSEY, P.A.
Entity Type:Organization
Organization Name:TAKE CARE HEALTH NEW JERSEY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HEGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-925-4733
Mailing Address - Street 1:1901 E VOORHEES ST
Mailing Address - Street 2:MS 640
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61834-4509
Mailing Address - Country:US
Mailing Address - Phone:855-925-4733
Mailing Address - Fax:217-709-2345
Practice Address - Street 1:1408 DELSEA DR
Practice Address - Street 2:
Practice Address - City:DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08096-4101
Practice Address - Country:US
Practice Address - Phone:855-925-4733
Practice Address - Fax:217-709-2345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-19
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0193917Medicaid
NJ141133Medicare PIN