Healthcare Provider Details

I. General information

NPI: 1689961963
Provider Name (Legal Business Name): KENNEDY HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2011
Last Update Date: 07/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

454 HURFFVILLE CROSSKEYS RD
SEWELL NJ
08080-2339
US

IV. Provider business mailing address

454 HURFFVILLE CROSSKEYS RD
SEWELL NJ
08080-2339
US

V. Phone/Fax

Practice location:
  • Phone: 856-582-1419
  • Fax: 856-582-7661
Mailing address:
  • Phone: 856-582-1419
  • Fax: 856-582-7661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. SHAWN THURBER
Title or Position: SENIOR CLINICIAN
Credential:
Phone: 856-582-1419