Provider Demographics
NPI:1457861684
Name:HIGHPOINT DAS PROGRAM LLC
Entity Type:Organization
Organization Name:HIGHPOINT DAS PROGRAM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:TISCHLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-364-4466
Mailing Address - Street 1:139 OCEAN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-3668
Mailing Address - Country:US
Mailing Address - Phone:732-364-4466
Mailing Address - Fax:732-364-7725
Practice Address - Street 1:162 BROAD ST
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-1603
Practice Address - Country:US
Practice Address - Phone:908-788-5979
Practice Address - Fax:908-788-0960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0268593Medicaid