Provider Demographics
NPI:1710968987
Name:COUNTY OF PASSAIC DEPARTMENT OF FINANCE
Entity Type:Organization
Organization Name:COUNTY OF PASSAIC DEPARTMENT OF FINANCE
Other - Org Name:PREAKNESS HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FISCAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-585-2189
Mailing Address - Street 1:305 OLDHAM RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470
Mailing Address - Country:US
Mailing Address - Phone:973-585-2189
Mailing Address - Fax:973-790-1903
Practice Address - Street 1:305 OLDHAM RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470
Practice Address - Country:US
Practice Address - Phone:973-585-2189
Practice Address - Fax:973-790-1903
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF PASSAIC DEPARTMENT OF FINANCE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-07
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ061617314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4497309Medicaid
NJ315361Medicare ID - Type Unspecified