NPIMap

Organization Active NPI

Christian Health Care Center

  • Mental Illness Intermediate Care Facility
  • Wyckoff, NJ
National Provider Identifier
1922194331
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Intermediate Care FacilityTaxonomy code 310500000X
License
060204 Issued in NJ
Legal business name
CHRISTIAN HEALTH CARE CENTER
Practice address
301 Sicomac Ave
Wyckoff, NJ 07481-2159
Phone
(201) 848-5200
Fax
(201) 848-5493
NPI assigned
Oct 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kevin A Stagg
Title
Executive Vice President/Cfo
Phone
(201) 848-5200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Intermediate Care Facility 310500000X 060204 NJ Primary

Addresses

Primary practice location

301 Sicomac Ave
Wyckoff, NJ 07481-2159

Mailing address

301 Sicomac Ave
Wyckoff, NJ 07481-2159
Phone (201) 848-5200

Other identifiers 1

IdentifierTypeStateIssuer
4463510MedicaidNJ

National Provider Directory

National Provider Directory
Tax ID family
Dr Richard Ilver7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

301 Sicomac Ave
Wyckoff, NJ 07481
Phone (201) 848-5200

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1922194331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 SICOMAC AVE",
            "city": "WYCKOFF",
            "state": "NJ",
            "postal_code": "074812159",
            "telephone_number": "201-848-5200",
            "fax_number": "201-848-5493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 SICOMAC AVE",
            "city": "WYCKOFF",
            "state": "NJ",
            "postal_code": "074812159",
            "telephone_number": "201-848-5200",
            "fax_number": "201-848-5493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHRISTIAN HEALTH CARE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STAGG",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT/CFO",
        "authorized_official_telephone_number": "201-848-5200"
    },
    "taxonomies": [
        {
            "code": "310500000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Mental Illness",
            "state": "NJ",
            "license": "060204",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4463510",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wyckoff, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.