| NPI | 1508273483 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY CANCELARICH Incorporator 917-670-0469 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NJ 44SC05590300) |
| Enumeration Date | 2014-07-12 |
| Last Update Date | 2014-07-12 |