MEDICARE: A REVOLVING DOOR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1346694155
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A REVOLVING DOOR

Provider Business Mailing Address
First Line	:	94 STEVENS AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07305-3054
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	94 STEVENS AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07305-3054
Country	:	US
Telephone Number	:	252-903-0768
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	LISA MERCER
Credential	:
Telephone Number	:	252-903-0768

Provider Enumeration Date	:	04/18/2016
Last Update Date	:	04/18/2016

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