Provider Demographics
NPI:1437697414
Name:CUMBERLAND COUNTY GUIDANCE CENTER
Entity Type:Organization
Organization Name:CUMBERLAND COUNTY GUIDANCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:H.
Authorized Official - Middle Name:DIETER
Authorized Official - Last Name:HOVERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:856-825-6810
Mailing Address - Street 1:2038 CARMEL RD
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-9754
Mailing Address - Country:US
Mailing Address - Phone:856-825-6810
Mailing Address - Fax:856-327-9020
Practice Address - Street 1:814 E ELMER ST
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-4725
Practice Address - Country:US
Practice Address - Phone:856-691-8579
Practice Address - Fax:856-691-8625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ405010148251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0545783Medicaid