Provider Demographics
NPI:1811408107
Name:HACKENSACK MERIDIAN AMBULATORY CARE, INC.
Entity Type:Organization
Organization Name:HACKENSACK MERIDIAN AMBULATORY CARE, INC.
Other - Org Name:THE WILLOWS AT HOLMDEL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR FINANCE ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-481-8529
Mailing Address - Street 1:3349 HWY 138 BLDG C
Mailing Address - Street 2:SUITE A
Mailing Address - City:WALL
Mailing Address - State:NJ
Mailing Address - Zip Code:07719
Mailing Address - Country:US
Mailing Address - Phone:732-751-3624
Mailing Address - Fax:
Practice Address - Street 1:713 N BEERS ST
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1503
Practice Address - Country:US
Practice Address - Phone:732-847-3766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-13
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0362271Medicaid