Lakewood Resource and Referral Center Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Lakewood, NJ
NPI 1194436360 · NPPES record last updated Feb 2, 2023
Key facts
- NPI
- 1194436360
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- LAKEWOOD RESOURCE AND REFERRAL CENTER INC
- Practice address
- 1171 River Avenue
Lakewood, NJ 08701 - Phone
- (732) 364-2144
- Fax
- (732) 364-3559
- NPI assigned
- Dec 8, 2022
- Organization subpart
- No
Authorized official
- Name
- David Friedman
- Title
- C.E.O.
- Phone
- (732) 364-2144
Other NPIs on the same Medicare enrollment 5
Other NPIs with the same Medicare PAC ID 4
Corporate family (same tax ID) 6
Practitioners 118
-
Yitzchok Mehlman, PMHNP
-
Maurice Mosseri, MD
-
Calli Stratton, PMHNP-BC
-
Chaya Dusya Wilhelm, FNP - BC
-
Eliyahu E Fuchs, MD
-
Shoshana Bacon, M.D.
-
Tracie Yvette Barberi, DSW, L.C.S.W.
-
Nicole Barone, APN
-
Chana Chapler, FNP
-
Dawn Marie Conover, MSW, LCSW
-
Amy Rose Cusack, FNP-C
-
Esther Davoudi, NP
-
Eliyahu Finkel, PA-C
-
Shawlom Francis, L.C.S.W
-
Yaakov Z Friedman, LCSW, LCADC,
-
Katherine Gallagher, PA-C
-
Blima Katz, PA-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 31D2278858 | Center for Health Education | Certificate of waiver | Mar 23, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NJ
Federally qualified health center certification: CCN 311000
- Legal name
- LAKEWOOD RESOURCE AND REFERRAL CENTER INC
- Doing business as
- CENTER FOR HEALTH EDUCATION, MEDICINE AND DENTISTRY
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Dec 27, 2023
- Last certification
- Dec 27, 2023
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 1171 River Ave
Lakewood, NJ 87015610
All disclosed owners & managing parties 1
| Name | Role | Since | Share |
|---|---|---|---|
| David Friedman |
Corporate Officer |
Jun 1, 2023 | |
| W-2 Managing Employee |
Jun 1, 2023 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080307000331 | NJ | Part B Supplier - Clinic/Group Practice | 6901981497 |
Receives reassigned benefits from 190 practitioners 5 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Jackson, NJ; Lakewood, NJ |
| O20231227001161 | NJ | Part a Provider - Federally Qualified Health Center (FQHC) | 6901981497 | Practice locations: Lakewood, NJ |
National Provider Directory
- Tax ID family
- Lakewood Resource and Referral Center Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
1171 River Avenue
Lakewood, NJ 08701
Mailing address
1771 Madison Ave
Lakewood, NJ 08701
Phone (732) 364-2144
Other names
- Center for Health Education, Medicine and Dentistry
Other providers in Lakewood, NJ
- Lakewood Pediatric Dental Associates
- Lakewood Pharmacy LLC
- Lakewood Physical Therapy and Acupuncture
- Lakewood Resource & Referral Center
- Lakewood Resource and Referral Center Inc
- Lakewood Resource and Referral Center, Inc.
- Lakewood Resource and Referral Center, Inc.
- Lakewood Resource and Referral Center, Inc.
- Lakewood Resource and Referral Center, Inc.
- Lakewood Speech and Language Center
All providers in Lakewood, 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 Feb 2, 2023. 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.