Visiting Nurse Association of Central Jersey Community Health Center I
Organization Active NPI Federally Qualified Health Center (FQHC) · Keansburg, NJ
NPI 1104964550 · NPPES record last updated Dec 4, 2017
Key facts
- NPI
- 1104964550
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- VISITING NURSE ASSOCIATION OF CENTRAL JERSEY COMMUNITY HEALTH CENTER I
- Practice address
- 100 Main Street
Keansburg, NJ 07734 - Phone
- (732) 787-1250
- Fax
- (732) 787-4079
- NPI assigned
- Feb 1, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. Gary S Linington
- Title
- Executive Director
- Phone
- (732) 502-5151
Other NPIs on the same Medicare enrollment 4
Practitioners 1
-
Kimberly Hope Mora, A-GNP-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040107000585 | NJ | Part B Supplier - Clinic/Group Practice | 1456250679 |
Receives reassigned benefits from 91 practitioners 4 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Asbury Park, NJ; Freehold, NJ; Keyport, NJ; Red Bank, NJ |
National Provider Directory
Locations
100 Main St
Keansburg, NJ 07734
Phone (732) 264-1163
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | |||
| Federally Qualified Health Center (FQHC) | 261QF0400X | NJ | Yes |
Addresses
Primary practice location
100 Main Street
Keansburg, NJ 07734
Mailing address
1301 Main Street
Asbury Park, NJ 07712
Phone (732) 774-6333
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0119148 | Medicaid | NJ |
Other providers in Keansburg, NJ
- Anderson F Tsai
- Universal Progressions LLC
- Vanessa Mae S. Abrina
- Vbvr2, LTD.
- George Nicholas Veneziano
- Kayla M West
- YMCA of the Jersey Shore
- YMCA of the Jersey Shore
- YMCA of the Jersey Shore
All providers in Keansburg, NJ · Federally Qualified Health Center (FQHC) in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 4, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.