Provider Demographics
NPI:1114541273
Name:PRASADA CENTER FOR WELLBEING
Entity Type:Organization
Organization Name:PRASADA CENTER FOR WELLBEING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEP
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:V
Authorized Official - Last Name:SHELDON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MBA
Authorized Official - Phone:973-685-5668
Mailing Address - Street 1:112 E SHAWNEE TRL
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07885-2920
Mailing Address - Country:US
Mailing Address - Phone:973-814-0106
Mailing Address - Fax:
Practice Address - Street 1:181 HOWARD BLVD STE L
Practice Address - Street 2:
Practice Address - City:MT ARLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07856-2314
Practice Address - Country:US
Practice Address - Phone:973-685-5668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ048998Medicaid
NJ0622621Medicaid
NJ0532614Medicaid