Provider Demographics
NPI:1518009588
Name:PRINCETON HEALTHCARE SYSTEM, A NEW JERSEY NON-PROFIT CORPORATION
Entity Type:Organization
Organization Name:PRINCETON HEALTHCARE SYSTEM, A NEW JERSEY NON-PROFIT CORPORATION
Other - Org Name:PENN MEDICINE PRINCETON HOUSE BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GUILHERME
Authorized Official - Middle Name:SIMOES
Authorized Official - Last Name:VALLADARES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-853-7112
Mailing Address - Street 1:905 HERRONTOWN RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-1901
Mailing Address - Country:US
Mailing Address - Phone:609-497-3300
Mailing Address - Fax:
Practice Address - Street 1:905 HERRONTOWN RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-1901
Practice Address - Country:US
Practice Address - Phone:609-497-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRINCETON HEALTHCARE SYSTEM, A NEW JERSEY NON-PROFIT CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ273R00000X, 276400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4455360OtherAETNA CH
NJ4606554OtherAETNA NOB
NJ0013018OtherAETNA PH
NJ7383142OtherAETNA HAM
NJ310902OtherHORIZON MEDI PH
NJ6427074OtherAETNA HERR
NJ4142306Medicaid
NJ7350660OtherAETNA MTL
NJ310902OtherHORIZON MEDI PH
NJ7350660OtherAETNA MTL
NJ310010Medicare Oscar/Certification