1639577513 NPI number — ATLANTICARE BEHAVIORAL HEALTH, 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 1639577513 NPI number — ATLANTICARE BEHAVIORAL HEALTH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATLANTICARE BEHAVIORAL HEALTH, 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:
1639577513
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/18/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6550 DELILAH RD STE 301
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EGG HARBOR TOWNSHIP
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08234-5102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-272-8580
Provider Business Mailing Address Fax Number:
609-645-7343

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 SCARBOROUGH DR FL 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EGG HARBOR TOWNSHIP
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08234-4897
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-645-7600
Provider Business Practice Location Address Fax Number:
609-645-7343
Provider Enumeration Date:
12/09/2014

Additional Information

Authorized Official

Authorized Official Last Name:
DREW
Authorized Official First Name:
JULIE
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
609-645-7601

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  2000138 , 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: 0437948 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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