Provider Demographics
NPI:1629122601
Name:MORNING GLORY BEHAVIORAL HEALTH PARTIAL CARE PROGRAM LLC
Entity Type:Organization
Organization Name:MORNING GLORY BEHAVIORAL HEALTH PARTIAL CARE PROGRAM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-918-9905
Mailing Address - Street 1:3443 HWY 66
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-2764
Mailing Address - Country:US
Mailing Address - Phone:732-918-9905
Mailing Address - Fax:732-918-9907
Practice Address - Street 1:3443 HWY 66
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-2764
Practice Address - Country:US
Practice Address - Phone:732-918-9905
Practice Address - Fax:732-918-9907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2010-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ10120-01-05261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0063207Medicaid