Provider Demographics
NPI:1740842889
Name:RUTHERFORD SWIM ASSOCIATION INC.
Entity type:Organization
Organization Name:RUTHERFORD SWIM ASSOCIATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZZARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-567-9739
Mailing Address - Street 1:128 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-1944
Mailing Address - Country:US
Mailing Address - Phone:732-567-9739
Mailing Address - Fax:
Practice Address - Street 1:56 ELLIOTT PL
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-1965
Practice Address - Country:US
Practice Address - Phone:732-567-9739
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No385HR2050XRespite Care FacilityRespite CareRespite Care Camp
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child