Provider Demographics
NPI:1497979827
Name:INTERIM HEALTHCARE OF SOUTH JERSEY, INC
Entity Type:Organization
Organization Name:INTERIM HEALTHCARE OF SOUTH JERSEY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTORELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-354-2120
Mailing Address - Street 1:1873 BRUNSWICK AVENUE
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08638
Mailing Address - Country:US
Mailing Address - Phone:609-393-4545
Mailing Address - Fax:609-989-8873
Practice Address - Street 1:76 W JIMMIE LEES ROAD
Practice Address - Street 2:
Practice Address - City:ABSECON
Practice Address - State:NJ
Practice Address - Zip Code:08201
Practice Address - Country:US
Practice Address - Phone:609-748-9766
Practice Address - Fax:609-748-9711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0016205251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
1508923863OtherNPI NUMBER
NJ0091910Medicaid