Provider Demographics
NPI:1053544049
Name:RWJ RAHWAY CARECENTER, LLC
Entity type:Organization
Organization Name:RWJ RAHWAY CARECENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:
Authorized Official - Last Name:TICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-499-6086
Mailing Address - Street 1:300 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:GARWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07027-1312
Mailing Address - Country:US
Mailing Address - Phone:908-232-1439
Mailing Address - Fax:908-232-1439
Practice Address - Street 1:300 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:GARWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07027-1312
Practice Address - Country:US
Practice Address - Phone:225-363-2172
Practice Address - Fax:225-363-2278
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL AT RAHWAY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-25
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB074721261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0239208Medicaid
NJ0239208Medicaid