Provider Demographics
NPI:1609551233
Name:AYDAN BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:AYDAN BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:
Authorized Official - Last Name:STAFFORD
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:856-449-4664
Mailing Address - Street 1:629 E WOOD ST STE 308
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-3731
Mailing Address - Country:US
Mailing Address - Phone:856-449-4664
Mailing Address - Fax:
Practice Address - Street 1:629 E WOOD ST STE 308
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-3731
Practice Address - Country:US
Practice Address - Phone:856-449-4664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AYDAN GLOBAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty