| NPI | 1730694688 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANA JAWORSKI Billing Supervisor 201-935-3322 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2017-12-13 |
| Last Update Date | 2017-12-13 |