Provider Demographics
NPI:1750336467
Name:HOSPICE AT BERGEN COMMUNITY HEALTH CARE
Entity type:Organization
Organization Name:HOSPICE AT BERGEN COMMUNITY HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-358-3000
Mailing Address - Street 1:400 OLD HOOK RD
Mailing Address - Street 2:SUITE G3
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-2732
Mailing Address - Country:US
Mailing Address - Phone:201-358-2900
Mailing Address - Fax:201-358-2989
Practice Address - Street 1:400 OLD HOOK RD
Practice Address - Street 2:SUITE G3
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-2732
Practice Address - Country:US
Practice Address - Phone:201-358-2900
Practice Address - Fax:201-358-2989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22254251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ311529Medicare ID - Type UnspecifiedMEDICARE PROVIDER #