Provider Demographics
NPI:1619408044
Name:PRINCETON CHILD DEVELOPMENT INSTITUTE
Entity Type:Organization
Organization Name:PRINCETON CHILD DEVELOPMENT INSTITUTE
Other - Org Name:FAMILY FOCUS MOUNTAINVIEW
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:R
Authorized Official - Last Name:PROGAR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, BCBA-D
Authorized Official - Phone:609-924-6280
Mailing Address - Street 1:300 COLD SOIL RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-2002
Mailing Address - Country:US
Mailing Address - Phone:609-924-6280
Mailing Address - Fax:609-924-4119
Practice Address - Street 1:55 PERRY DR
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08628-1710
Practice Address - Country:US
Practice Address - Phone:609-883-7377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRINCETON CHILD DEVELOPMENT INSTITUTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJGH309AU320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities