Provider Demographics
NPI:1285843748
Name:RUTGERS-UNIVERSITY BEHAVIORAL HEALTH CARE
Entity Type:Organization
Organization Name:RUTGERS-UNIVERSITY BEHAVIORAL HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, FINANCE & TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:X
Authorized Official - Last Name:COLFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-235-5940
Mailing Address - Street 1:671 HOES LN
Mailing Address - Street 2:P.O. BOX 1392
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-5627
Mailing Address - Country:US
Mailing Address - Phone:732-235-5940
Mailing Address - Fax:732-235-5626
Practice Address - Street 1:671 HOES LN
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-5627
Practice Address - Country:US
Practice Address - Phone:732-235-5940
Practice Address - Fax:732-235-5626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7442505Medicaid