Provider Demographics
NPI:1629342696
Name:BOARD OF CHOSEN FREEHOLDERS OF SALEM COUNTY
Entity Type:Organization
Organization Name:BOARD OF CHOSEN FREEHOLDERS OF SALEM COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIEBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-935-7510
Mailing Address - Street 1:141 CENTER STREET
Mailing Address - Street 2:PO BOX 274
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080
Mailing Address - Country:US
Mailing Address - Phone:888-723-4494
Mailing Address - Fax:888-449-6833
Practice Address - Street 1:110 5TH STREET
Practice Address - Street 2:SUITE 500
Practice Address - City:SALEM
Practice Address - State:NJ
Practice Address - Zip Code:08079-1912
Practice Address - Country:US
Practice Address - Phone:856-935-7510
Practice Address - Fax:856-935-8483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-08
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ360251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ733307Medicaid