Provider Demographics
NPI:1639202708
Name:COUNTY OF GLOUCESTER, DEPT. OF HEALTH AND SENIOR SERVICES
Entity Type:Organization
Organization Name:COUNTY OF GLOUCESTER, DEPT. OF HEALTH AND SENIOR SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-218-4134
Mailing Address - Street 1:PO BOX 337
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-7337
Mailing Address - Country:US
Mailing Address - Phone:856-853-3353
Mailing Address - Fax:856-845-6234
Practice Address - Street 1:204 E HOLLY AVE
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2641
Practice Address - Country:US
Practice Address - Phone:856-262-4136
Practice Address - Fax:856-262-4109
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF GLOUCESTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-14
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0056901Medicaid
NJ0061603Medicaid