Provider Demographics
NPI:1902940901
Name:FORREST S. CHILTON 3RD MEMORIAL HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:FORREST S. CHILTON 3RD MEMORIAL HOSPITAL ASSOCIATION
Other - Org Name:CHILTON MEMORIAL HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:RICHETTI
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:973-831-5202
Mailing Address - Street 1:97 WEST PARKWAY
Mailing Address - Street 2:
Mailing Address - City:POMPTON PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07444-1647
Mailing Address - Country:US
Mailing Address - Phone:973-831-5202
Mailing Address - Fax:973-831-5493
Practice Address - Street 1:97 WEST PARKWAY
Practice Address - Street 2:
Practice Address - City:POMPTON PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07444-1647
Practice Address - Country:US
Practice Address - Phone:973-831-5202
Practice Address - Fax:973-831-5493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJFACILITY 11401273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4136225Medicaid
NJ31S017Medicare Oscar/Certification