1053468462 NPI number — GUIDING LIGHT BEHAVIORAL HEALTH, INC.

Table of content: MARY EMILY SHEFFIELD MD (NPI 1811100050)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053468462 NPI number — GUIDING LIGHT BEHAVIORAL HEALTH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GUIDING LIGHT BEHAVIORAL HEALTH, INC.
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:
1053468462
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 368
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKHURST
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07755-0368
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-531-2626
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1930 HECK AVE
Provider Second Line Business Practice Location Address:
BLDG. 3, SUITE 1
Provider Business Practice Location Address City Name:
NEPTUNE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07753-4476
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-774-0911
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LUNDY
Authorized Official First Name:
HOWARD
Authorized Official Middle Name:
C
Authorized Official Title or Position:
VP
Authorized Official Telephone Number:
732-531-2626

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X , 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: 6968309 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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