Provider Demographics
NPI:1952770927
Name:THE JEWISH RENAISSANCE FOUNDATION, INC.
Entity Type:Organization
Organization Name:THE JEWISH RENAISSANCE FOUNDATION, INC.
Other - Org Name:JRF COMMUNITY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-324-2114
Mailing Address - Street 1:1931 OAK TREE RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2072
Mailing Address - Country:US
Mailing Address - Phone:732-482-9600
Mailing Address - Fax:732-372-0800
Practice Address - Street 1:1931 OAK TREE RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2072
Practice Address - Country:US
Practice Address - Phone:732-482-9600
Practice Address - Fax:732-372-0800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-21
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ24975261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0562289Medicaid