Healthcare Provider Details

I. General information

NPI: 1043717150
Provider Name (Legal Business Name): CAMDEN COUNTY CORRECTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2018
Last Update Date: 04/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 FEDERAL ST
CAMDEN NJ
08103-1121
US

IV. Provider business mailing address

330 FEDERAL ST
CAMDEN NJ
08103-1121
US

V. Phone/Fax

Practice location:
  • Phone: 856-580-5733
  • Fax: 856-964-3207
Mailing address:
  • Phone: 856-580-5733
  • Fax: 856-964-3207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code261QP2400X
TaxonomyPrison Health Clinic/Center
License Number
License Number StateNJ

VIII. Authorized Official

Name: ALFRED D CARR
Title or Position: CORRECTIONS/RENTRY SPECIAL SERVICES
Credential:
Phone: 609-828-8111