MEDICARE: COUNTY OF GLOUCESTER, DEPT. OF HEALTH AND SENIOR SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251K00000X	Public Health or Welfare Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639202708
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF GLOUCESTER, DEPT. OF HEALTH AND SENIOR SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 337
Second Line	:
City	:	WOODBURY
State	:	NJ
Zip	:	08096-7337
Country	:	US
Telephone Number	:	856-853-3353
Fax Number	:	856-845-6234

Provider Business Practice Location Address
First Line	:	204 E HOLLY AVE
Second Line	:
City	:	SEWELL
State	:	NJ
Zip	:	08080-2641
Country	:	US
Telephone Number	:	856-262-4136
Fax Number	:	856-262-4109

Authorized Official
Title or Position	:	FISCAL OFFICER
Name	:	KAREN CHRISTINA
Credential	:
Telephone Number	:	856-218-4134

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	03/21/2019

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