Provider Demographics
NPI:1003507021
Name:MILESTONE ASSOCIATES IN MENTAL HEALTH LLC
Entity Type:Organization
Organization Name:MILESTONE ASSOCIATES IN MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANAKAY
Authorized Official - Middle Name:K
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-323-4381
Mailing Address - Street 1:550 HARBORTOWN BLVD
Mailing Address - Street 2:
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-3088
Mailing Address - Country:US
Mailing Address - Phone:973-323-4381
Mailing Address - Fax:732-486-8699
Practice Address - Street 1:550 HARBORTOWN BLVD
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-3088
Practice Address - Country:US
Practice Address - Phone:973-323-4381
Practice Address - Fax:732-486-8699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ92-38348452Medicaid