Provider Demographics
NPI:1457488066
Name:NEW DIRECTIONS BEHAVORIAL HEALTH CENTER
Entity Type:Organization
Organization Name:NEW DIRECTIONS BEHAVORIAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARGROVE JR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-242-6599
Mailing Address - Street 1:9 LINCOLN PARK
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-2301
Mailing Address - Country:US
Mailing Address - Phone:973-242-6599
Mailing Address - Fax:973-242-2118
Practice Address - Street 1:9 LINCOLN PARK
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-2301
Practice Address - Country:US
Practice Address - Phone:973-242-6599
Practice Address - Fax:973-242-2118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ100180105251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8702403Medicaid