Provider Demographics
NPI:1619463437
Name:PLATINUM HEARTS A NJ NONPROFIT CORPORATION
Entity Type:Organization
Organization Name:PLATINUM HEARTS A NJ NONPROFIT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:E
Authorized Official - Last Name:BENJAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-772-1805
Mailing Address - Street 1:24 COMMERCE ST STE 1002
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-4060
Mailing Address - Country:US
Mailing Address - Phone:862-772-1805
Mailing Address - Fax:862-772-1820
Practice Address - Street 1:808 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:MILLTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08850-2019
Practice Address - Country:US
Practice Address - Phone:732-609-2247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-04
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities