Provider Demographics
NPI:1932763091
Name:HACKENSACK MERIDIAN AMBULATORY CARE, INC.
Entity Type:Organization
Organization Name:HACKENSACK MERIDIAN AMBULATORY CARE, INC.
Other - Org Name:HACKENSACK MERIDIAN HAVEN HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-751-3713
Mailing Address - Street 1:1340 CAMPUS PKWY STE A3
Mailing Address - Street 2:
Mailing Address - City:WALL TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-6830
Mailing Address - Country:US
Mailing Address - Phone:732-751-3700
Mailing Address - Fax:732-751-3701
Practice Address - Street 1:80 JAMES ST
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3938
Practice Address - Country:US
Practice Address - Phone:732-321-7769
Practice Address - Fax:732-744-5531
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HMH RESIDENTIAL CARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-24
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5171601Medicaid