1598125619 NPI number — THE FAMILY RESOURCE NETWORK

Table of content: (NPI 1598125619)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598125619 NPI number — THE FAMILY RESOURCE NETWORK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE FAMILY RESOURCE NETWORK
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:
1598125619
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 MILLSTONE ROAD
Provider Second Line Business Mailing Address:
BUILDING 300, SUITE 270
Provider Business Mailing Address City Name:
E. WINDSOR
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-392-4900
Provider Business Mailing Address Fax Number:
609-392-5621

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 FLATBROOK RD
Provider Second Line Business Practice Location Address:
LINWOOD MACDONALD YMCA/CAMP NOVA
Provider Business Practice Location Address City Name:
SANDYSTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07826-5109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-392-4900
Provider Business Practice Location Address Fax Number:
609-392-5621
Provider Enumeration Date:
03/02/2016

Additional Information

Authorized Official

Authorized Official Last Name:
TRATHEN
Authorized Official First Name:
VERONICA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
609-392-4900

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0463990 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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