Provider Demographics
NPI:1518445881
Name:HOUSE OF REFUGE FOR WOMEN
Entity Type:Organization
Organization Name:HOUSE OF REFUGE FOR WOMEN
Other - Org Name:HOUSE OF REFUGE FOR WOMEN
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:
Authorized Official - Last Name:DURRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:LCADC LPC MHSC
Authorized Official - Phone:856-397-8022
Mailing Address - Street 1:23A HATHAWAY DR
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-2523
Mailing Address - Country:US
Mailing Address - Phone:856-397-8022
Mailing Address - Fax:
Practice Address - Street 1:23A HATHAWAY DR
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-2523
Practice Address - Country:US
Practice Address - Phone:856-397-8022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness