Provider Demographics
NPI:1033490529
Name:UNION ASSOCIATION OF THE CHILDREN'S HOME OF BURLINGTON COUNTY
Entity Type:Organization
Organization Name:UNION ASSOCIATION OF THE CHILDREN'S HOME OF BURLINGTON COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEITSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:609-267-1550
Mailing Address - Street 1:243 PINE ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-2201
Mailing Address - Country:US
Mailing Address - Phone:609-267-1550
Mailing Address - Fax:609-261-5672
Practice Address - Street 1:230 JACOBS CREEK RD
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08560-1403
Practice Address - Country:US
Practice Address - Phone:609-267-1550
Practice Address - Fax:609-261-5672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1100320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0268780Medicaid