Provider Demographics
NPI:1841588639
Name:KENNEDY HEALTH SYSTEMS
Entity Type:Organization
Organization Name:KENNEDY HEALTH SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BH CASE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:DECANDIA
Authorized Official - Last Name:MCGUIRE
Authorized Official - Suffix:
Authorized Official - Credentials:BA, COGS, SAC
Authorized Official - Phone:856-488-6545
Mailing Address - Street 1:36 PTOLEMY CT
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-2027
Mailing Address - Country:US
Mailing Address - Phone:856-582-9650
Mailing Address - Fax:
Practice Address - Street 1:2201 CHAPEL AVE W
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-2048
Practice Address - Country:US
Practice Address - Phone:856-488-6545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4140206Medicaid