Provider Demographics
NPI:1043371446
Name:INTERIM HEALTHCARE OF NORTHWEST NJ, INC.
Entity type:Organization
Organization Name:INTERIM HEALTHCARE OF NORTHWEST NJ, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:STANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-756-1515
Mailing Address - Street 1:265 DURHAM AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-2504
Mailing Address - Country:US
Mailing Address - Phone:908-756-1515
Mailing Address - Fax:908-756-5915
Practice Address - Street 1:2414 MORRIS AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-5732
Practice Address - Country:US
Practice Address - Phone:973-762-8071
Practice Address - Fax:973-762-9495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0012203251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8034401Medicaid