Provider Demographics
NPI:1679112981
Name:PASSION CARE CENTER OF MONMOUTH
Entity Type:Organization
Organization Name:PASSION CARE CENTER OF MONMOUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-909-8264
Mailing Address - Street 1:187 FAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-4140
Mailing Address - Country:US
Mailing Address - Phone:267-909-8264
Mailing Address - Fax:215-525-0272
Practice Address - Street 1:42 MARKWOOD DR
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-2349
Practice Address - Country:US
Practice Address - Phone:267-909-8264
Practice Address - Fax:215-525-0272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-03
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty