1821473588 NPI number — WILLOWGLEN ACADEMY-NEW JERSEY, INC.

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 1821473588 NPI number — WILLOWGLEN ACADEMY-NEW JERSEY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLOWGLEN ACADEMY-NEW JERSEY, 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:
6
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:
1821473588
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8 WILSON DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPARTA
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07871-3491
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-579-3700
Provider Business Mailing Address Fax Number:
973-579-1786

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1857 OLD FREEHOLD ROAD
Provider Second Line Business Practice Location Address:
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:
973-579-3700
Provider Business Practice Location Address Fax Number:
973-579-1786
Provider Enumeration Date:
07/23/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BATES
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
973-579-3700

Provider Taxonomy Codes

  • Taxonomy code: 320900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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