Provider Demographics
NPI:1235658022
Name:ATLANTICARE BEHAVIORAL HEALTH, INC
Entity Type:Organization
Organization Name:ATLANTICARE BEHAVIORAL HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, INFORMATION MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HELMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-484-6417
Mailing Address - Street 1:6550 DELILAH RD STE 301
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-5102
Mailing Address - Country:US
Mailing Address - Phone:609-272-7806
Mailing Address - Fax:609-645-7343
Practice Address - Street 1:120 S WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-1804
Practice Address - Country:US
Practice Address - Phone:609-561-7911
Practice Address - Fax:609-645-7343
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTICARE BEHAVIORAL HEALTH, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-13
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ400053504251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2477203Medicaid