Provider Demographics
NPI:1760508147
Name:THE EXCHANGE CLUB FAMILY CENTER FOR THE PREVENTION OF CHILD ABUSE
Entity Type:Organization
Organization Name:THE EXCHANGE CLUB FAMILY CENTER FOR THE PREVENTION OF CHILD ABUSE
Other - Org Name:CARING KIDS EXCHANGE CLUB
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONRAD-MCGARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:609-399-9110
Mailing Address - Street 1:854 ASBURY AVE
Mailing Address - Street 2:
Mailing Address - City:OCEAN CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08226-3600
Mailing Address - Country:US
Mailing Address - Phone:609-399-9110
Mailing Address - Fax:609-399-9910
Practice Address - Street 1:854 ASBURY AVE
Practice Address - Street 2:
Practice Address - City:OCEAN CITY
Practice Address - State:NJ
Practice Address - Zip Code:08226-3600
Practice Address - Country:US
Practice Address - Phone:609-399-9110
Practice Address - Fax:609-399-9910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0020168Medicaid