Basic Information
| Provider Information | |||||||||
| NPI: | 1861629156 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CLARA MAASS MEDICAL CENTER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CLARA MAASS MEDICAL CENTER TRANSITIONAL CARE UNIT | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 CLARA MAASS DR | ||||||||
| Address2: | |||||||||
| City: | BELLEVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071093550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9734502000 | ||||||||
| FaxNumber: | 9738444908 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 CLARA MAASS DR | ||||||||
| Address2: | |||||||||
| City: | BELLEVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071093550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9734502008 | ||||||||
| FaxNumber: | 9738444908 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2009 | ||||||||
| LastUpdateDate: | 12/20/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CLYNE | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
| AuthorizedOfficialMiddleName: | ELLEN | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9734502002 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BARNABAS HEALTH | ||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | PHD | ||||||||
| NPICertificationDate: | 12/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 10701 | NJ | N | Nursing & Custodial Care Facilities | Skilled Nursing Facility | 314000000X | NJ | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 4135504 | 05 | NJ | MEDICAID |