Provider Demographics
NPI:1043375843
Name:ST GEORGE BEHAVIORAL CARE, INC
Entity Type:Organization
Organization Name:ST GEORGE BEHAVIORAL CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:F
Authorized Official - Last Name:BREDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-381-5700
Mailing Address - Street 1:2366 ST GEORGE AVENUE
Mailing Address - Street 2:
Mailing Address - City:RAHWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07065
Mailing Address - Country:US
Mailing Address - Phone:732-381-5700
Mailing Address - Fax:732-381-5827
Practice Address - Street 1:2366 ST GEORGE AVENUE
Practice Address - Street 2:
Practice Address - City:RAHWAY
Practice Address - State:NJ
Practice Address - Zip Code:07065
Practice Address - Country:US
Practice Address - Phone:732-381-5700
Practice Address - Fax:732-381-5827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ726030000OtherMIS
NJ334239OtherMHN
NJ334239OtherMHN