Provider Demographics
NPI:1629055694
Name:INSPIRA MEDICAL CENTER WOODBURY, INC.
Entity Type:Organization
Organization Name:INSPIRA MEDICAL CENTER WOODBURY, INC.
Other - Org Name:INSPIRA INPATIENT ADULT BEHAVIORAL HEALTH WOODBURY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT COO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-845-0100
Mailing Address - Street 1:509 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-1617
Mailing Address - Country:US
Mailing Address - Phone:856-845-0100
Mailing Address - Fax:856-384-1358
Practice Address - Street 1:509 N BROAD ST
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-1617
Practice Address - Country:US
Practice Address - Phone:856-845-0100
Practice Address - Fax:856-384-1358
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INSPIRA MEDICAL CENTER WOODBURY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-12-29
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31S081273R00000X
NJ10801283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
No273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3676137Medicaid
NJ3676137Medicaid
NJ31S081Medicare Oscar/Certification