Provider Demographics
NPI:1285631234
Name:KAREN ANN QUINLAN MEMORIAL FOUNDATION
Entity Type:Organization
Organization Name:KAREN ANN QUINLAN MEMORIAL FOUNDATION
Other - Org Name:KAREN ANN QUINLAN HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARLINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHETTING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-383-0115
Mailing Address - Street 1:99 SPARTA AVE
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-2614
Mailing Address - Country:US
Mailing Address - Phone:973-383-0115
Mailing Address - Fax:973-383-6889
Practice Address - Street 1:99 SPARTA AVE
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-2614
Practice Address - Country:US
Practice Address - Phone:973-383-0115
Practice Address - Fax:973-383-6889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-06
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22656251G00000X
PA17041601251G00000X
251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0097209Medicaid
PA391704Medicare Oscar/Certification
NJ311509Medicare ID - Type Unspecified