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DSH310064AX ATLANTICARE REGIONAL MEDICAL CENTER (Active)
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Main Details
Name
ATLANTICARE REGIONAL MEDICAL CENTER
Subdivision Name
Child Partial Hospitalization Program
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH310064AX
Medicare Provider Number
310064
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/14/2015
Participating Start Date
4/1/2015
Participating Approval Date
3/11/2015
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
AtlantiCare
Hak Kim, Chief Financial Officer
(609) 569-7031
Primary Contact
AtlantiCare Regional Medical Center
Timothy Joseph Ryan, Reimbursement Manager
(609) 383-2805
Addresses
Street Address
6010 Black Horse Pike
Egg Harbor Township, NJ 08234
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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