Provider Demographics
NPI:1679974174
Name:RUNNELLS BH OPERATING LLC
Entity Type:Organization
Organization Name:RUNNELLS BH OPERATING LLC
Other - Org Name:RUNNELLS SPECIALIZED HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES-EDOUARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-360-8083
Mailing Address - Street 1:49 HAMLIN RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-2951
Mailing Address - Country:US
Mailing Address - Phone:718-360-8083
Mailing Address - Fax:718-732-2481
Practice Address - Street 1:40 WATCHUNG WAY
Practice Address - Street 2:
Practice Address - City:BERKELEY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07922-2600
Practice Address - Country:US
Practice Address - Phone:718-360-8083
Practice Address - Fax:718-732-2481
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUNNELLS VENTURES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22001282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0199338Medicaid
NJ3682307Medicaid
NJ0199338Medicaid
NJ314027Medicare PIN