Provider Demographics
NPI:1992862361
Name:INTERIM HEALTHCARE MANAGED SERVICES
Entity Type:Organization
Organization Name:INTERIM HEALTHCARE MANAGED SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTORELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-393-4545
Mailing Address - Street 1:1466 HOOPER AVE
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-2827
Mailing Address - Country:US
Mailing Address - Phone:732-341-0330
Mailing Address - Fax:732-341-2269
Practice Address - Street 1:1873 BRUNSWICK AVENUE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08638-0043
Practice Address - Country:US
Practice Address - Phone:609-393-4545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0016204251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0086819Medicaid