Provider Demographics
NPI:1043350135
Name:CAPE ATLANTIC INTEGRATED NETWORK FOR KIDS
Entity Type:Organization
Organization Name:CAPE ATLANTIC INTEGRATED NETWORK FOR KIDS
Other - Org Name:CAPE ATLANTIC INK
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHTER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:609-829-2038
Mailing Address - Street 1:1413 CANTILLON BLVD
Mailing Address - Street 2:
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-2058
Mailing Address - Country:US
Mailing Address - Phone:609-829-2038
Mailing Address - Fax:609-829-2886
Practice Address - Street 1:1413 CANTILLON BLVD
Practice Address - Street 2:
Practice Address - City:MAYS LANDING
Practice Address - State:NJ
Practice Address - Zip Code:08330-2058
Practice Address - Country:US
Practice Address - Phone:609-829-2038
Practice Address - Fax:609-829-2886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8457701Medicaid