Provider Demographics
NPI:1700379054
Name:KIDS IN TRANSITION
Entity Type:Organization
Organization Name:KIDS IN TRANSITION
Other - Org Name:CFG RESIDENTIALS, LLC - KIDS IN TRANSITION
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DOWDELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:856-541-9212
Mailing Address - Street 1:1000 ATLANTIC AVE STE 402
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08104-1132
Mailing Address - Country:US
Mailing Address - Phone:856-541-9212
Mailing Address - Fax:856-797-4830
Practice Address - Street 1:1000 ATLANTIC AVE STE 402
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08104-1132
Practice Address - Country:US
Practice Address - Phone:856-541-9212
Practice Address - Fax:856-797-4830
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KIDS IN TRANSITION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1629222005Medicaid