Provider Demographics
NPI:1275787590
Name:RANCH HOPE COWAN PROGRAM
Entity Type:Organization
Organization Name:RANCH HOPE COWAN PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DORRELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:856-935-1555
Mailing Address - Street 1:P.O. BOX 325
Mailing Address - Street 2:45 SAWMILL RD.
Mailing Address - City:ALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08001-0325
Mailing Address - Country:US
Mailing Address - Phone:856-935-1555
Mailing Address - Fax:856-935-5189
Practice Address - Street 1:45 SAWMILL RD.
Practice Address - Street 2:
Practice Address - City:ALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08001-0325
Practice Address - Country:US
Practice Address - Phone:856-935-1555
Practice Address - Fax:856-935-5189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1580322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children