| NPI | 1063958221 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEEANN WAGNER Director 732-290-9040 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NJ 100051504) |
| Enumeration Date | 2017-01-12 |
| Last Update Date | 2017-01-12 |