Organization
ST. MARY'S HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT BODNAR (DIRECTOR OF PATIENT ACCOUNTS)
(973) 365-3012
Entity
Organization
Contact information
Practice address
530 MAIN AVE, PASSAIC, NJ 07055-5700
(973) 470-3507
Mailing address
350 BOULEVARD, PASSAIC, NJ 07055-2840
(973) 365-3012
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
30407 R05 00 41
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4550013
—
NJ
Enumeration date
04/03/2007
Last updated
08/22/2020
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