Provider Demographics
NPI:1033279914
Name:VISIONQUEST OF NEW JERSEY
Entity Type:Organization
Organization Name:VISIONQUEST OF NEW JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT - SERVICE DELIVERY
Authorized Official - Prefix:DR
Authorized Official - First Name:BETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ROSICA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:610-486-2280
Mailing Address - Street 1:108 ROUTE 72
Mailing Address - Street 2:
Mailing Address - City:NEW LISBON
Mailing Address - State:NJ
Mailing Address - Zip Code:08064
Mailing Address - Country:US
Mailing Address - Phone:609-894-4826
Mailing Address - Fax:609-894-8109
Practice Address - Street 1:108 ROUTE 72
Practice Address - Street 2:
Practice Address - City:NEW LISBON
Practice Address - State:NJ
Practice Address - Zip Code:08064-0370
Practice Address - Country:US
Practice Address - Phone:609-894-4826
Practice Address - Fax:609-894-8109
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VISIONQUEST NATIONAL LTD.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-11
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0019666251S00000X
NJ1670320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0182320Medicaid
NJ0166715Medicaid
NJ0019666Medicaid
NJ8372705Medicaid