Provider Demographics
NPI:1205040169
Name:NEW DIRECTIONS BEHAVIORAL HEALTH CENTER
Entity Type:Organization
Organization Name:NEW DIRECTIONS BEHAVIORAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARGROVE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:973-242-6599
Mailing Address - Street 1:9 LINCOLN PARK
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-2301
Mailing Address - Country:US
Mailing Address - Phone:973-242-6599
Mailing Address - Fax:973-242-1976
Practice Address - Street 1:9 LINCOLN PARK
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-2301
Practice Address - Country:US
Practice Address - Phone:973-242-6599
Practice Address - Fax:973-242-1976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ100100105261QM0850X
NJ23255261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0019194Medicaid
NJ0156744Medicaid
NJ8702403Medicaid