1205671567 NPI number — STILL MIND HEALTH LLC

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 1205671567 NPI number — STILL MIND HEALTH LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STILL MIND HEALTH LLC
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:
1205671567
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
415 SICKLERVILLE RD UNIT 81
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SICKLERVILLE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08081-8003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-359-4895
Provider Business Mailing Address Fax Number:
732-561-1354

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
415 SICKLERVILLE RD UNIT 81
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SICKLERVILLE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08081-8003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-855-7279
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/28/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
UGO-OGBUEWU
Authorized Official First Name:
CHIOMA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/APN
Authorized Official Telephone Number:
732-359-4895

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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