Provider Demographics
NPI:1588607725
Name:STATE OF NEW JERSEY OMB CENTRALIZED PAYROLL
Entity type:Organization
Organization Name:STATE OF NEW JERSEY OMB CENTRALIZED PAYROLL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-285-2266
Mailing Address - Street 1:PO BOX 1513
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08362-1513
Mailing Address - Country:US
Mailing Address - Phone:856-696-6000
Mailing Address - Fax:856-696-6056
Practice Address - Street 1:1676 E LANDIS AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08362-1513
Practice Address - Country:US
Practice Address - Phone:856-696-6000
Practice Address - Fax:856-696-6056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4474201Medicaid
NJ528583OtherPROVIDER GROUP
NJ528583OtherPROVIDER GROUP