Provider Demographics
NPI:1164784294
Name:HMH CARRIER CLINIC, INC.
Entity Type:Organization
Organization Name:HMH CARRIER CLINIC, INC.
Other - Org Name:HACKENSACK MERIDIAN HEALTH CARRIER CLINIC EAST MOUNTAIN YOUTH LODGE LO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT - CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDOLPH
Authorized Official - Middle Name:S
Authorized Official - Last Name:JACOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-281-1000
Mailing Address - Street 1:252 ROUTE 601
Mailing Address - Street 2:
Mailing Address - City:BELLE MEAD
Mailing Address - State:NJ
Mailing Address - Zip Code:08502-3923
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:252 ROUTE 601
Practice Address - Street 2:
Practice Address - City:BELLE MEAD
Practice Address - State:NJ
Practice Address - Zip Code:08502-3923
Practice Address - Country:US
Practice Address - Phone:908-281-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARRIER CLINIC, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-14
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ51806323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility