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General NPI Number Information
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NPI Number | 1366723504
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Entity Type | Organization
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Legal Business Name | KENNEDY HOSPITAL
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Dates
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Enumeration Date | 09/01/2011
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Last Update Date | 09/01/2011
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Provider Practice Location Address
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Address Line | 2201 CHAPEL AVE W
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City | CHERRY HILL
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State | NJ
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Zip | 08002-2048
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Country | US
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Telephone | 856-488-6576
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Fax | 856-488-6793
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Provider Business Mailing Address
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Address Line | 1128 THACKARY CT
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City | VOORHEES
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State | NJ
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Zip | 08043-1820
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Country | US
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Telephone | 856-488-6576
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Fax | 856-488-6793
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Authorized Official
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Title or Position | LSW
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Name | MRS. KYMBERLY CALHOUN
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Credential | LSW
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Telephone | 856-488-6576
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | 44SL05533000
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License Number State | NJ
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