Provider Demographics
NPI:1710397799
Name:UNION ASSOCIATION OF THE CHILDREN'S HOME OF BURLINGTON COUNTY
Entity Type:Organization
Organization Name:UNION ASSOCIATION OF THE CHILDREN'S HOME OF BURLINGTON COUNTY
Other - Org Name:THE CHILDREN'S HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:FISCAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:VINCENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-267-1550
Mailing Address - Street 1:243 PINE ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-2201
Mailing Address - Country:US
Mailing Address - Phone:609-267-1550
Mailing Address - Fax:609-614-4480
Practice Address - Street 1:243 PINE ST
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060-2201
Practice Address - Country:US
Practice Address - Phone:609-267-1550
Practice Address - Fax:609-614-4480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8847304Medicaid