Provider Demographics
NPI:1487019675
Name:INSTITUTE FOR BEHAVIORAL HEALTH AND DEVELOPMENTAL DISABILITIES
Entity Type:Organization
Organization Name:INSTITUTE FOR BEHAVIORAL HEALTH AND DEVELOPMENTAL DISABILITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:K
Authorized Official - Last Name:CEASER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-604-2433
Mailing Address - Street 1:1980 SPRINGFIELD AVE
Mailing Address - Street 2:SUITE 4L
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-3440
Mailing Address - Country:US
Mailing Address - Phone:888-604-2433
Mailing Address - Fax:862-930-4862
Practice Address - Street 1:1980 SPRINGFIELD AVE
Practice Address - Street 2:SUITE 4L
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-3440
Practice Address - Country:US
Practice Address - Phone:888-604-2433
Practice Address - Fax:862-930-4862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-15
Last Update Date:2016-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0490270Medicaid