1336217421 NPI number — GREATER TRENTON CMHC INC.

Table of content: (NPI 1336217421)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336217421 NPI number — GREATER TRENTON CMHC INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREATER TRENTON CMHC 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:
GREATER TRENTON BEHAVIORAL HEALTHCARE
Provider Other Organization Name Type Code:
3
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:
1336217421
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1393
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRENTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08607-1393
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-396-6788
Provider Business Mailing Address Fax Number:
609-989-1245

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 SPRUCE ST
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
TRENTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08638-3957
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-396-6788
Provider Business Practice Location Address Fax Number:
609-989-1245
Provider Enumeration Date:
11/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MONAHAN
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
609-396-6788

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , with the licence number:  103040909 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 103040105 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 103040603 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 103040104 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 103040704 , 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: 7610009 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0047201 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7495803 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4549309 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0019852 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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