Provider Demographics
NPI:1073241576
Name:DIAMOND VALLEY BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:DIAMOND VALLEY BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:KALU
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:609-496-0285
Mailing Address - Street 1:49 EQUESTRIAN DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-3062
Mailing Address - Country:US
Mailing Address - Phone:609-496-0285
Mailing Address - Fax:
Practice Address - Street 1:563 HIGH ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016
Practice Address - Country:US
Practice Address - Phone:609-496-0285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty