Provider Demographics
NPI:1629284302
Name:HOLY NAME MEDICAL CENTER INC.
Entity Type:Organization
Organization Name:HOLY NAME MEDICAL CENTER INC.
Other - Org Name:HOLY NAME HOSPITAL ADULT DAY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AVP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-833-7016
Mailing Address - Street 1:718 TEANECK ROAD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4249
Mailing Address - Country:US
Mailing Address - Phone:201-833-3000
Mailing Address - Fax:201-833-4486
Practice Address - Street 1:718 TEANECK RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4245
Practice Address - Country:US
Practice Address - Phone:201-833-3000
Practice Address - Fax:201-833-4486
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOLY NAME MEDICAL CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-16
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ10205311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4135407Medicaid