Provider Demographics
NPI:1225610082
Name:LACKA BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:LACKA BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:N
Authorized Official - Last Name:OGUONU
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:609-577-9741
Mailing Address - Street 1:PO BOX 422
Mailing Address - Street 2:
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505-0422
Mailing Address - Country:US
Mailing Address - Phone:609-577-9741
Mailing Address - Fax:609-372-2483
Practice Address - Street 1:2911 LAKEWOOD RD
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT BORO
Practice Address - State:NJ
Practice Address - Zip Code:08742-2871
Practice Address - Country:US
Practice Address - Phone:609-577-9741
Practice Address - Fax:609-372-2483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty