Provider Demographics
NPI:1801001581
Name:SOMERSET HILLS RESIDENTIAL TREATMENT CENTER, INC.
Entity Type:Organization
Organization Name:SOMERSET HILLS RESIDENTIAL TREATMENT CENTER, INC.
Other - Org Name:SOMERSET HILLS RES TRLMT CTR
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:
Authorized Official - Last Name:AMEDEO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-469-6900
Mailing Address - Street 1:1275 BOUND BROOK RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MIDDLESEX
Mailing Address - State:NJ
Mailing Address - Zip Code:08846-1486
Mailing Address - Country:US
Mailing Address - Phone:732-764-8800
Mailing Address - Fax:732-764-8808
Practice Address - Street 1:206 MOUNT HOREB RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-5622
Practice Address - Country:US
Practice Address - Phone:732-469-6900
Practice Address - Fax:732-469-0024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1600322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8716005Medicaid