1558428961 NPI number — PREFERRED BEHAVIORAL HEALTH OF NJ

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558428961 NPI number — PREFERRED BEHAVIORAL HEALTH OF NJ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREFERRED BEHAVIORAL HEALTH OF NJ
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:
WRAP AROUND PROGRAM
Provider Other Organization Name Type Code:
5
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:
1558428961
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PREFERRED BEHAVIORAL HEALTH OF NEW JERSEY
Provider Second Line Business Mailing Address:
P.O.BOX 2036
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-458-1700
Provider Business Mailing Address Fax Number:
732-785-3296

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
591 LAKEHURST ROAD
Provider Second Line Business Practice Location Address:
PREFERRED BEHAVIORAL HEALTH OF NJ WRAP AROUND PROGRAM
Provider Business Practice Location Address City Name:
TOMS RIVER
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-458-1700
Provider Business Practice Location Address Fax Number:
732-785-3296
Provider Enumeration Date:
01/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ANGELINI
Authorized Official First Name:
MARY PAT
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
732-458-1700

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0018872 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com