=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548485154
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTERIM HEALTHCARE MANAGED SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2007
-----------------------------------------------------
Last Update Date | 04/10/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1873 BRUNSWICK AVENUE
-----------------------------------------------------
City | TRENTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-393-4545
-----------------------------------------------------
Fax | 609-989-8873
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1873 BRUNSWICK AVENUE
-----------------------------------------------------
City | TRENTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-393-4545
-----------------------------------------------------
Fax | 609-989-8873
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT OF OPERATIONS
-----------------------------------------------------
Name | MS. JACQUELINE BARTORELLI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 856-354-2120
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number | HP0016202
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------