Provider Demographics
NPI:1598808941
Name:BANCROFT NEUROHEALTH
Entity Type:Organization
Organization Name:BANCROFT NEUROHEALTH
Other - Org Name:LINDENS/CAMPUS
Other - Org Type:Other Name
Authorized Official - Title/Position:AVP PATIENT FINANCIAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-348-1181
Mailing Address - Street 1:1255 CALDWELL RD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-3220
Mailing Address - Country:US
Mailing Address - Phone:800-774-5516
Mailing Address - Fax:856-429-4755
Practice Address - Street 1:311 WALTON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054
Practice Address - Country:US
Practice Address - Phone:856-348-1172
Practice Address - Fax:856-216-1269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X, 320600000X, 320900000X, 385H00000X
PRF101322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental DisabilitiesGroup - Multi-Specialty
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223139095OtherBRS ID #