Provider Demographics
NPI:1508106634
Name:MAINLAND REGIONAL HIGH SCHOOL
Entity Type:Organization
Organization Name:MAINLAND REGIONAL HIGH SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHILD STUDY DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-927-4151
Mailing Address - Street 1:1301 OAK AVE
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-1653
Mailing Address - Country:US
Mailing Address - Phone:609-927-4151
Mailing Address - Fax:609-927-1942
Practice Address - Street 1:1301 OAK AVE
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1653
Practice Address - Country:US
Practice Address - Phone:609-927-4151
Practice Address - Fax:609-927-1942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0179078Medicaid