Provider Demographics
NPI:1952395030
Name:KENNEDY HEALTH FACILITIES, INC.
Entity type:Organization
Organization Name:KENNEDY HEALTH FACILITIES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, AMBULATORY SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-566-5279
Mailing Address - Street 1:535 EGG HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-2335
Mailing Address - Country:US
Mailing Address - Phone:856-582-3170
Mailing Address - Fax:856-582-3143
Practice Address - Street 1:535 EGG HARBOR RD
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2335
Practice Address - Country:US
Practice Address - Phone:856-582-3170
Practice Address - Fax:856-582-3143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-06
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ060806314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ315231OtherHORIZON BLUE CROSS
FL612914300OtherFEDERAL BLACK LUNG
NJ13145OtherAETNA USHEALTHCARE
NJ4478304Medicaid
PA0000591100OtherINDEPENDENCE BLUE CROSS
FL612914300OtherFEDERAL BLACK LUNG