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DSH310003A PALISADES MEDICAL CENTER (Active)
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Main Details
Name
PALISADES MEDICAL CENTER
Subdivision Name
PALISADES MEDICAL CENTER INC-Mental Health Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH310003A
Medicare Provider Number
310003
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/5/2017
Participating Start Date
10/1/2017
Participating Approval Date
7/12/2017
Last Recertification Date
8/26/2024
Contacts
Authorizing Official
Palisades Medical Center
Heather Hussein, VP Operations
(201) 854-5226
Primary Contact
Palisades Medical Center
Joan Mozeika, Director of Clinical Support and Pharmacy
(201) 854-5140
Addresses
Street Address
7101 KENNEDY BLVD
PALISADES MEDICAL CENTER MENTAL HEALTH CENTER
NORTH BERGEN, NJ 07047-3934
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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