Provider Demographics
NPI:1689074601
Name:MOUNT CARMEL GUILD BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:MOUNT CARMEL GUILD BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTERVELT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-596-7989
Mailing Address - Street 1:590 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07107-2522
Mailing Address - Country:US
Mailing Address - Phone:973-596-5101
Mailing Address - Fax:973-485-1978
Practice Address - Street 1:590 N 7TH ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07107-2522
Practice Address - Country:US
Practice Address - Phone:973-596-5101
Practice Address - Fax:973-485-1978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0218341Medicaid
NJ0218341Medicaid