Provider Demographics
NPI:1801034921
Name:INTERDEPENDENCE, LLC
Entity Type:Organization
Organization Name:INTERDEPENDENCE, LLC
Other - Org Name:CHILDREN'S BILINGUAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:CASILDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMINGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-980-5830
Mailing Address - Street 1:PO BOX 1089
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-0452
Mailing Address - Country:US
Mailing Address - Phone:973-980-5830
Mailing Address - Fax:973-661-3101
Practice Address - Street 1:295 CENTRE ST
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-2703
Practice Address - Country:US
Practice Address - Phone:973-980-5830
Practice Address - Fax:973-661-3101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0161951Medicaid