Healthcare Provider Details

I. General information

NPI: 1104964550
Provider Name (Legal Business Name): VISITING NURSE ASSOCIATION OF CENTRAL JERSEY COMMUNITY HEALTH CENTER I
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 12/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MAIN STREET
KEANSBURG NJ
07734
US

IV. Provider business mailing address

1301 MAIN STREET
ASBURY PARK NJ
07712
US

V. Phone/Fax

Practice location:
  • Phone: 732-787-1250
  • Fax: 732-787-4079
Mailing address:
  • Phone: 732-774-6333
  • Fax: 732-774-0313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNJ

VIII. Authorized Official

Name: MR. GARY S LININGTON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 732-502-5151