Provider Demographics
NPI:1639519978
Name:LANDMARK CENTER FOR HOLISTIC HEALTH & WELLNESS
Entity Type:Organization
Organization Name:LANDMARK CENTER FOR HOLISTIC HEALTH & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MINOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-343-1399
Mailing Address - Street 1:253 MARTIN LUTHER KING JR DR
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-3427
Mailing Address - Country:US
Mailing Address - Phone:201-451-8888
Mailing Address - Fax:866-521-3486
Practice Address - Street 1:253 MARTIN LUTHER KING JR DR
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-3427
Practice Address - Country:US
Practice Address - Phone:201-451-8888
Practice Address - Fax:866-521-3486
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LANDMARK MANAGEMENT GROUP, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2000563101YA0400X, 261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity HealthGroup - Single Specialty