1720797574 NPI number — GARDEN STATE TREATMENT CENTER BH 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 1720797574 NPI number — GARDEN STATE TREATMENT CENTER BH LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GARDEN STATE TREATMENT CENTER BH 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:
1720797574
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7050 W PALMETTO PARK ROAD SUITE 15 #181
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOCA RATON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33433
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-818-9901
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
350 SPARTA AVE STE A201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPARTA
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07871-1120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-818-9901
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/21/2022

Additional Information

Authorized Official

Authorized Official Last Name:
QUINN
Authorized Official First Name:
KARA
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING DIRECTOR
Authorized Official Telephone Number:
561-818-9901

Provider Taxonomy Codes

  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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