Provider Demographics
NPI:1942208137
Name:MERIDIAN HOSPITALS CORPORATION
Entity Type:Organization
Organization Name:MERIDIAN HOSPITALS CORPORATION
Other - Org Name:JERSEY SHORE UNIVERSITY MEDICAL CENTER- PSYCH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VP, FINANCE & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:GANTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-751-7520
Mailing Address - Street 1:2020 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-6109
Mailing Address - Country:US
Mailing Address - Phone:732-897-7130
Mailing Address - Fax:
Practice Address - Street 1:1945 ROUTE 33
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4859
Practice Address - Country:US
Practice Address - Phone:732-775-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERIDIAN HOSPITALS CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-12
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3675700Medicaid
NJ3675700Medicaid