Provider Demographics
NPI:1134489537
Name:RESCUE MISSION OF TRENTON
Entity Type:Organization
Organization Name:RESCUE MISSION OF TRENTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PARBATTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-815-3985
Mailing Address - Street 1:98 CARROLL ST
Mailing Address - Street 2:PO BOX 790
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08609-1008
Mailing Address - Country:US
Mailing Address - Phone:609-815-3985
Mailing Address - Fax:
Practice Address - Street 1:98 CARROLL ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08609-1008
Practice Address - Country:US
Practice Address - Phone:609-815-3985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2000107261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0092461Medicaid