Provider Demographics
NPI:1164815437
Name:RESCUE MISSION OF TRENTON
Entity Type:Organization
Organization Name:RESCUE MISSION OF TRENTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARY GAY
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBOTT-YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-396-2183
Mailing Address - Street 1:98 CARROLL ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08609-1008
Mailing Address - Country:US
Mailing Address - Phone:609-396-2183
Mailing Address - Fax:609-695-5199
Practice Address - Street 1:72 EWING ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08609-1027
Practice Address - Country:US
Practice Address - Phone:609-396-2183
Practice Address - Fax:609-695-5199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
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