Provider Demographics
NPI:1003030495
Name:CHALLENGE PROGRAM OF NEW JERSEY INC
Entity Type:Organization
Organization Name:CHALLENGE PROGRAM OF NEW JERSEY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:CASAC
Authorized Official - Phone:973-345-9100
Mailing Address - Street 1:5 COLT ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07505-1401
Mailing Address - Country:US
Mailing Address - Phone:973-345-9100
Mailing Address - Fax:973-345-9110
Practice Address - Street 1:152 MARKET ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07505-1724
Practice Address - Country:US
Practice Address - Phone:973-345-9100
Practice Address - Fax:973-345-9110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22583261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8102503Medicaid
NJ7639309Medicaid
NJ7512503Medicaid