Provider Demographics
NPI:1609874296
Name:KAREN ANN QUINLAN MEMORIAL FOUNDATION
Entity type:Organization
Organization Name:KAREN ANN QUINLAN MEMORIAL FOUNDATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CECELIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:CLAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:973-383-0115
Mailing Address - Street 1:99 SPARTA AVE
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-2614
Mailing Address - Country:US
Mailing Address - Phone:973-383-0115
Mailing Address - Fax:973-383-6889
Practice Address - Street 1:755 MEMORIAL PKWY
Practice Address - Street 2:BLDG 303 SUITE 303A
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-2748
Practice Address - Country:US
Practice Address - Phone:973-383-0115
Practice Address - Fax:973-383-6889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22270251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7711808Medicaid
NJ317091Medicare ID - Type Unspecified