1053640201 NPI number — GUIDING LIGHT BEHAVIORAL HEALTH, INC.

Table of content: (NPI 1053640201)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053640201 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:
GUIDING LIGHT DRUG AND ALCOHOL TREATMENT SERVICES
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:
1053640201
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2009
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:
732-531-8377

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:
732-774-4061
Provider Enumeration Date:
12/17/2009

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: 261QR0405X , with the licence number:  2000357-09 , 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: 0212393 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0212326 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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