Healthcare Provider Details

I. General information

NPI: 1376543462
Provider Name (Legal Business Name): COUNTY OF ATLANTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 DOLPHIN AVE
NORTHFIELD NJ
08225-2015
US

IV. Provider business mailing address

235 DOLPHIN AVE
NORTHFIELD NJ
08225-2015
US

V. Phone/Fax

Practice location:
  • Phone: 609-645-5955
  • Fax: 609-645-5939
Mailing address:
  • Phone: 609-645-5955
  • Fax: 609-645-5939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number060101
License Number StateNJ

VIII. Authorized Official

Name: MRS. JANE LUGO
Title or Position: COMPTROLLER/CFO
Credential: CCFO
Phone: 609-343-2258