Provider Demographics
NPI:1609320258
Name:COMUNIDAD UNIDA PARA LA REHABILITACION DE ADICTOS
Entity Type:Organization
Organization Name:COMUNIDAD UNIDA PARA LA REHABILITACION DE ADICTOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:PLAZA
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:973-622-3570
Mailing Address - Street 1:35 LINCOLN PARK
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-2390
Mailing Address - Country:US
Mailing Address - Phone:973-622-3570
Mailing Address - Fax:
Practice Address - Street 1:75 LINCOLN PARK
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-2303
Practice Address - Country:US
Practice Address - Phone:973-622-3570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1000059324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7606303Medicaid
NJ0507474Medicaid