Provider Demographics
NPI:1760901623
Name:PRODIGAL SONS AND DAUGHTERS BEHAVIORAL HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:PRODIGAL SONS AND DAUGHTERS BEHAVIORAL HEALTHCARE SERVICES
Other - Org Name:PRODIGAL SONS AND DAUGHTERS BEHAVIORAL HEALTHCARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:DUANE
Authorized Official - Last Name:MUHAMMAD-HAMILTON
Authorized Official - Suffix:SR
Authorized Official - Credentials:MS, LCADC, ICADC
Authorized Official - Phone:973-678-3966
Mailing Address - Street 1:PO BOX 28109
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101-2486
Mailing Address - Country:US
Mailing Address - Phone:973-703-3262
Mailing Address - Fax:
Practice Address - Street 1:60 EVERGREEN PL STE 904
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2114
Practice Address - Country:US
Practice Address - Phone:973-678-3966
Practice Address - Fax:973-678-3968
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRODIGAL SONS AND DAUGHTERS REDIRECTION SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-12
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ100230104251S00000X
NJ2000609324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility