Provider Demographics
NPI:1588044895
Name:LADACIN NETWORK
Entity Type:Organization
Organization Name:LADACIN NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLESIMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-493-5900
Mailing Address - Street 1:1703 KNEELEY BLVD
Mailing Address - Street 2:
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-7622
Mailing Address - Country:US
Mailing Address - Phone:732-493-5900
Mailing Address - Fax:732-493-5980
Practice Address - Street 1:191 MILL CREEK RD
Practice Address - Street 2:
Practice Address - City:BAYVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08721-1373
Practice Address - Country:US
Practice Address - Phone:732-269-8022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1700265261Medicaid
NJ1932379906Medicaid
NJ1053790519Medicaid
NJ1245619709Medicaid
NJ1780063248Medicaid
NJ1396966438Medicaid
NJ1588834550Medicaid