Provider Demographics
NPI: | 1003955824 |
---|---|
Name: | INHEALTH PA |
Entity Type: | Organization |
Organization Name: | INHEALTH PA |
Other - Org Name: | INHEALTH ASSOCIATES |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PRACTICE ADMINISTRATOR |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | KATHLEEN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | NIELSEN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | APRN BC |
Authorized Official - Phone: | 973-579-6700 |
Mailing Address - Street 1: | 15 STATE ROUTE 15 |
Mailing Address - Street 2: | |
Mailing Address - City: | LAFAYETTE |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 07848-2007 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 973-579-6700 |
Mailing Address - Fax: | 973-579-6830 |
Practice Address - Street 1: | 15 STATE ROUTE 15 |
Practice Address - Street 2: | |
Practice Address - City: | LAFAYETTE |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 07848-2007 |
Practice Address - Country: | US |
Practice Address - Phone: | 973-579-6700 |
Practice Address - Fax: | 973-579-6830 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | INHEALTH PA |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2007-02-06 |
Last Update Date: | 2010-08-04 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
No | 103TA0400X | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
No | 103TF0200X | Behavioral Health & Social Service Providers | Psychologist | Forensic | Group - Multi-Specialty |
No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
No | 2080P0006X | Allopathic & Osteopathic Physicians | Pediatrics | Developmental - Behavioral Pediatrics | Group - Multi-Specialty |
No | 364SP0809X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Adult | Group - Multi-Specialty |
No | 364SP0813X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Geropsychiatric | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NJ | 6003401 | Medicaid | |
NJ | 6003401 | Medicaid |