Provider Demographics
NPI:1104201870
Name:WILLOWGLEN ACADEMY-NEW JERSEY, INC.
Entity Type:Organization
Organization Name:WILLOWGLEN ACADEMY-NEW JERSEY, INC.
Other - Org Name:WGA DELWOOD
Other - Org Type:Other Name
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-579-3700
Mailing Address - Street 1:8 WILSON DRIVE
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-3491
Mailing Address - Country:US
Mailing Address - Phone:973-579-3700
Mailing Address - Fax:973-579-1786
Practice Address - Street 1:37 DELWOOD ROAD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002
Practice Address - Country:US
Practice Address - Phone:973-579-3700
Practice Address - Fax:973-579-1786
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILLOWGLEN ACADEMY-NEW JERSEY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities