1033490529 NPI number — UNION ASSOCIATION OF THE CHILDREN'S HOME OF BURLINGTON COUNTY

Table of content: (NPI 1033490529)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033490529 NPI number — UNION ASSOCIATION OF THE CHILDREN'S HOME OF BURLINGTON COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNION ASSOCIATION OF THE CHILDREN'S HOME OF BURLINGTON COUNTY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033490529
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
243 PINE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT HOLLY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08060-2201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-267-1550
Provider Business Mailing Address Fax Number:
609-261-5672

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
230 JACOBS CREEK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TITUSVILLE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08560-1403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-267-1550
Provider Business Practice Location Address Fax Number:
609-261-5672
Provider Enumeration Date:
08/29/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LEITSTEIN
Authorized Official First Name:
ROY
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
609-267-1550

Provider Taxonomy Codes

  • Taxonomy code: 320900000X , with the licence number:  1100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0268780 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".