Provider Demographics
NPI:1235574617
Name:KELSCH ASSOCIATES
Entity Type:Organization
Organization Name:KELSCH ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGINO
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:856-456-2022
Mailing Address - Street 1:368 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WESTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08093-1193
Mailing Address - Country:US
Mailing Address - Phone:856-456-2022
Mailing Address - Fax:856-456-4372
Practice Address - Street 1:368 BROADWAY
Practice Address - Street 2:
Practice Address - City:WESTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08093-1193
Practice Address - Country:US
Practice Address - Phone:856-456-2022
Practice Address - Fax:856-456-4372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ251B00000X, 251C00000X, 251S00000X, 320900000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1235574617Medicaid