Provider Demographics
NPI:1376944967
Name:UNION ASSOCIATION OF THE CHILDREN'S HOME OF BURLINGTON COUNTY, INC.
Entity Type:Organization
Organization Name:UNION ASSOCIATION OF THE CHILDREN'S HOME OF BURLINGTON COUNTY, INC.
Other - Org Name:LEGACY TREATMENT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-267-5656
Mailing Address - Street 1:1289 ROUTE 38
Mailing Address - Street 2:SUITE #203
Mailing Address - City:HAINESPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:08036-2730
Mailing Address - Country:US
Mailing Address - Phone:609-288-3067
Mailing Address - Fax:609-265-1895
Practice Address - Street 1:610 PEMBERTON BROWNS MILLS RD
Practice Address - Street 2:
Practice Address - City:PEMBERTON
Practice Address - State:NJ
Practice Address - Zip Code:08068-1537
Practice Address - Country:US
Practice Address - Phone:609-726-7155
Practice Address - Fax:609-894-8964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health