Provider Demographics
NPI:1366826646
Name:OCCUPATIONAL TRAINING CENTER OF BURLINGTON COUNTY
Entity Type:Organization
Organization Name:OCCUPATIONAL TRAINING CENTER OF BURLINGTON COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HAINES
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:609-267-6677
Mailing Address - Street 1:2 MANHATTAN DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-4120
Mailing Address - Country:US
Mailing Address - Phone:609-267-6677
Mailing Address - Fax:609-265-8418
Practice Address - Street 1:4 NEWTOWN LN
Practice Address - Street 2:
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-1912
Practice Address - Country:US
Practice Address - Phone:609-267-6677
Practice Address - Fax:609-265-8418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-16
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
320600000X
NJGH2274320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities