Organization Name: | KENNEDY HEALTH SYSTEM |
NPI Number: | 1033438643 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RUSS MICOLI (CORP. DIRECTOR, BEHAVIORAL HEALTH) |
Mailing Address: | 454 Hurffville Crosskeys Rd Sewell |
State: | NJ US |
Postal Code: | 080802339 |
Phone Number: | 8565821419 |
Fax Number: | 8565827661 |
NPI Enumeration Date: | 05/21/2010 |
NPI Last Update Date: | 05/21/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM0801X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
Taxonomy Definition: |