Provider Demographics
NPI:1588834550
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:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:BLACK
Authorized Official - Last Name:CARLESIMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-493-5900
Mailing Address - Street 1:1701 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 1:1701 KNEELEY BLVD
Practice Address - Street 2:
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-7622
Practice Address - Country:US
Practice Address - Phone:732-493-5900
Practice Address - Fax:732-493-5980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0012823Medicaid