MEDICARE: MT. CARMEL GUILD ICMS UNION

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	251S00000X	Community/Behavioral Health Agency		NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396811758
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MT. CARMEL GUILD ICMS UNION

Provider Business Mailing Address
First Line	:	590 N 7TH ST
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07107-2522
Country	:	US
Telephone Number	:	973-266-7992
Fax Number	:	973-596-4057

Provider Business Practice Location Address
First Line	:	505 SOUTH AVE E
Second Line	:
City	:	CRANFORD
State	:	NJ
Zip	:	07016-3246
Country	:	US
Telephone Number	:	908-497-3923
Fax Number	:

Authorized Official
Title or Position	:	ASSOCIATE EXECUTIVE DIRECTOR
Name	:	MS. ELIZABETH MCCLENDON
Credential	:
Telephone Number	:	973-266-7992

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	04/13/2011

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