MEDICARE: POSITIVE PAIRING HEALTH MANAGEMENT LLC

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	310400000X	Assisted Living Facility	06-03-07-16	NJ

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

General Provider Information

NPI Number	:	1871730598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POSITIVE PAIRING HEALTH MANAGEMENT LLC

Provider Business Mailing Address
First Line	:	128 IVY ST
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07106-2904
Country	:	US
Telephone Number	:	973-373-7300
Fax Number	:	973-373-4202

Provider Business Practice Location Address
First Line	:	128 IVY ST
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07106-2904
Country	:	US
Telephone Number	:	973-373-7300
Fax Number	:	973-373-4202

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. HATTIE ELIZABETH JOHNSON
Credential	:
Telephone Number	:	973-373-7300

Provider Enumeration Date	:	01/16/2009
Last Update Date	:	01/16/2009

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