# PRIME HEALTHCARE SERVICES - ST MICHAELS LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Saint Michael's Medical Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568825545
- **Authorized official:** CHRISTOPHER DOAN (CHIEF COMPLIANCE COUNSEL)
- **Authorized official phone:** (909) 235-4307

## Contact information

- **Practice address:** 111 CENTRAL AVE, NEWARK, NJ 07102-1909
- **Practice address phone:** (973) 877-2853
- **Practice address fax:** (973) 877-5367
- **Mailing address:** 111 CENTRAL AVE, NEWARK, NJ 07102-1909
- **Mailing address phone:** (973) 877-2853
- **Mailing address fax:** (973) 877-5367

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QE0700X | End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 10713 | NJ | — |
| 273R00000X | Psychiatric Hospital Unit | 10713 | NJ | — |
| 282N00000X | General Acute Care Hospital | 10713 | NJ | Yes |

## Other

- **Enumeration date:** 03/29/2016
- **Last updated:** 03/29/2016