Provider Demographics
NPI:1235830969
Name:ELSHIVA DEVELOPMENTAL SERVICES
Entity Type:Organization
Organization Name:ELSHIVA DEVELOPMENTAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSTAFA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-313-1080
Mailing Address - Street 1:397 BRIDGETON PIKE
Mailing Address - Street 2:
Mailing Address - City:MANTUA
Mailing Address - State:NJ
Mailing Address - Zip Code:08051-1925
Mailing Address - Country:US
Mailing Address - Phone:609-313-1080
Mailing Address - Fax:
Practice Address - Street 1:397 BRIDGETON PIKE
Practice Address - Street 2:
Practice Address - City:MANTUA
Practice Address - State:NJ
Practice Address - Zip Code:08051-1925
Practice Address - Country:US
Practice Address - Phone:609-313-1080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health