Provider Demographics
NPI:1033324850
Name:THE CHILDREN'S HOME SOCIETY OF NEW JERSEY
Entity Type:Organization
Organization Name:THE CHILDREN'S HOME SOCIETY OF NEW JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FISCAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-695-6274
Mailing Address - Street 1:635 S CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08611-1831
Mailing Address - Country:US
Mailing Address - Phone:609-695-6274
Mailing Address - Fax:609-394-5769
Practice Address - Street 1:635 S CLINTON AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08611-1831
Practice Address - Country:US
Practice Address - Phone:609-695-6274
Practice Address - Fax:609-394-5769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4020251V00000X
NJ210630104251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0025259Medicaid
NJ8834105Medicaid