Provider Demographics
NPI:1689093841
Name:PRIME HEALTHCARE SERVICES - ST. MARY'S PASSAIC, LLC
Entity Type:Organization
Organization Name:PRIME HEALTHCARE SERVICES - ST. MARY'S PASSAIC, LLC
Other - Org Name:ST. MARY'S HOSPITAL - SETON COMPREHENSIVE TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY, GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:909-235-4311
Mailing Address - Street 1:3300 E GUASTI RD
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-8655
Mailing Address - Country:US
Mailing Address - Phone:909-235-4311
Mailing Address - Fax:909-235-4419
Practice Address - Street 1:530 MAIN AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-5700
Practice Address - Country:US
Practice Address - Phone:973-470-3168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness