Healthcare Provider Details

I. General information

NPI: 1013033836
Provider Name (Legal Business Name): BERGEN COUNTY IMPROVEMENT AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 E RIDGEWOOD AVE
PARAMUS NJ
07652-4142
US

IV. Provider business mailing address

230 E RIDGEWOOD AVE BLDG 10
PARAMUS NJ
07652-4142
US

V. Phone/Fax

Practice location:
  • Phone: 201-967-4000
  • Fax: 201-225-7101
Mailing address:
  • Phone: 201-967-4001
  • Fax: 201-225-7101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number10201
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier4465415
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: MAURO RAGUSEO
Title or Position: EXECUTIVE DIRECTOR OF BCIA
Credential:
Phone: 201-336-6350