Provider Demographics
NPI:1043725161
Name:INTERVENTION SPECIALIST
Entity Type:Organization
Organization Name:INTERVENTION SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-289-0700
Mailing Address - Street 1:PO BOX 6063
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-9063
Mailing Address - Country:US
Mailing Address - Phone:973-953-8896
Mailing Address - Fax:
Practice Address - Street 1:583 CHERRY ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-1754
Practice Address - Country:US
Practice Address - Phone:973-953-8896
Practice Address - Fax:973-953-8896
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENTERPRISE ALLIANCE GROUP DBA INTERVENTION SPECIALIST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0501433OtherSAI