1770796575 NPI number — IRON RECOVERY AND WELLNESS CENTER, INC.

Table of content: (NPI 1770796575)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770796575 NPI number — IRON RECOVERY AND WELLNESS CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IRON RECOVERY AND WELLNESS CENTER, 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:
1770796575
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
132 PERRY STREET
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:
08618-3968
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-394-8988
Provider Business Mailing Address Fax Number:
609-396-5856

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
132 PERRY STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRENTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08618-3968
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-394-8988
Provider Business Practice Location Address Fax Number:
609-396-5856
Provider Enumeration Date:
05/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WOLFE
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
609-394-8988

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  2000345 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X , with the licence number: 2000345 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM2800X , with the licence number: NJ-10046-M , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0405X , with the licence number: 2000345; 2000078 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 183739 YBA4 . This is a "MEDICARE PROVIDER ID W/ AGENCY GROUP SUFFIX" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2000345 . This is a "DHS LICENSE- AMBULATORY CARE CONSISTING OF ADDICTION SERVICES & OTP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2000078 . This is a "DHS LICENSE- AMBULATORY CARE CONSISTING OF ADDICTION SERVICES" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0102903 . This is a "NJ MEDICAID PROVIDER ID: INDEPENDENT CLINIC- NARCOTIC & DRUG ABUSE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2000345 MV1-10 . This is a "DHS DMHAS MOBILE UNIT LICENSE #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 215114000 . This is a "MAGELLAN MIS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7603606 . This is a "WFNJ-SAI GROUP PROVIDER ID- INDEP CLINIC NARCOTIC & DRUG ABUSE TX" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: NJ-10046-M . This is a "SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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