Healthcare Provider Details

I. General information

NPI: 1053544049
Provider Name (Legal Business Name): RWJ RAHWAY CARECENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2009
Last Update Date: 09/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SOUTH AVE
GARWOOD NJ
07027-1312
US

IV. Provider business mailing address

300 SOUTH AVE
GARWOOD NJ
07027-1312
US

V. Phone/Fax

Practice location:
  • Phone: 225-363-2172
  • Fax: 225-363-2278
Mailing address:
  • Phone: 908-232-1439
  • Fax: 908-232-1439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number25MB074721
License Number StateNJ

VIII. Authorized Official

Name: MR. KIRK TICE
Title or Position: PRESIDENT & CEO
Credential:
Phone: 732-499-6086