Basic Information
| Provider Information | |||||||||
| NPI: | 1659616688 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ATLANTICARE REGIONAL MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 65 W JIMMIE LEEDS RD | ||||||||
| Address2: | |||||||||
| City: | POMONA | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082409102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6096521000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 65 W JIMMIE LEEDS RD | ||||||||
| Address2: | |||||||||
| City: | POMONA | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082409102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6096521000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2012 | ||||||||
| LastUpdateDate: | 12/03/2012 | ||||||||
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| AuthorizedOfficialLastName: | GREINER | ||||||||
| AuthorizedOfficialFirstName: | WALTER | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP FINANCE & CHIEF FINANCIAL OFFICE | ||||||||
| AuthorizedOfficialTelephone: | 6093832111 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 10102 | NJ | N | Hospitals | General Acute Care Hospital | 282N00000X | 10101 | NJ | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 4139402 | 05 | NJ | MEDICAID |