Provider Demographics
NPI:1689240483
Name:ST REMI LLC
Entity Type:Organization
Organization Name:ST REMI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ISIAKA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOLARINWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-282-5566
Mailing Address - Street 1:750 ROUTE 73 S STE 105A
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4142
Mailing Address - Country:US
Mailing Address - Phone:856-282-5566
Mailing Address - Fax:856-396-9917
Practice Address - Street 1:750 ROUTE 73 S STE 105A
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-4142
Practice Address - Country:US
Practice Address - Phone:856-282-5566
Practice Address - Fax:856-396-9917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-02
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)