Provider Demographics
NPI:1457330672
Name:KENNEDY UNIVERSITY HOSPITAL INC
Entity Type:Organization
Organization Name:KENNEDY UNIVERSITY HOSPITAL INC
Other - Org Name:KENNEDY HEALTH SYSTEMS EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:FORSYTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-627-5409
Mailing Address - Street 1:PO BOX 13704
Mailing Address - Street 2:30TH STREET STATION
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19101-3704
Mailing Address - Country:US
Mailing Address - Phone:856-782-9064
Mailing Address - Fax:856-782-9068
Practice Address - Street 1:140 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:LINDENWOLD
Practice Address - State:NJ
Practice Address - Zip Code:08021-7555
Practice Address - Country:US
Practice Address - Phone:856-782-9064
Practice Address - Fax:856-782-9068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-16
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJKENN003013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7809506Medicaid
NJ7809506Medicaid