Provider Demographics
NPI:1437501905
Name:DEDICATED GROUP HOMES
Entity Type:Organization
Organization Name:DEDICATED GROUP HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIENNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAUTRUCHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-625-9934
Mailing Address - Street 1:180 ALYSSA DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT ROYAL
Mailing Address - State:NJ
Mailing Address - Zip Code:08061-1071
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:180 ALYSSA DR
Practice Address - Street 2:
Practice Address - City:MOUNT ROYAL
Practice Address - State:NJ
Practice Address - Zip Code:08061-1071
Practice Address - Country:US
Practice Address - Phone:866-625-9934
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-08
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty