Provider Demographics
NPI:1730562455
Name:ROWAN INTEGRATED SPECIAL NEEDS BH
Entity type:Organization
Organization Name:ROWAN INTEGRATED SPECIAL NEEDS BH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MANAGED CARE & CONTRACT
Authorized Official - Prefix:
Authorized Official - First Name:KELI
Authorized Official - Middle Name:
Authorized Official - Last Name:WORKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-566-6831
Mailing Address - Street 1:PO BOX 71356
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19176-1356
Mailing Address - Country:US
Mailing Address - Phone:856-566-6413
Mailing Address - Fax:856-566-2797
Practice Address - Street 1:1474 TANYARD RD
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-4111
Practice Address - Country:US
Practice Address - Phone:856-566-6034
Practice Address - Fax:856-566-6208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-30
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJDW2417OtherRAILROAD MEDICARE
NJ0491829Medicaid
NJ0487317Medicaid
NJDW2417OtherRAILROAD MEDICARE