Provider Demographics
NPI: | 1821356148 |
---|---|
Name: | CUMBERLAND COUNTY GUIDANCE CENTER |
Entity Type: | Organization |
Organization Name: | CUMBERLAND COUNTY GUIDANCE CENTER |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | EXECUTIVE DIRECTOR |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | H. |
Authorized Official - Middle Name: | DIETER |
Authorized Official - Last Name: | HOVERMANN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MA |
Authorized Official - Phone: | 856-825-6810 |
Mailing Address - Street 1: | 2038 CARMEL RD |
Mailing Address - Street 2: | |
Mailing Address - City: | MILLVILLE |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 08332-9754 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 856-825-6810 |
Mailing Address - Fax: | 856-327-4281 |
Practice Address - Street 1: | 2038 CARMEL RD |
Practice Address - Street 2: | |
Practice Address - City: | MILLVILLE |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 08332-9754 |
Practice Address - Country: | US |
Practice Address - Phone: | 856-825-6810 |
Practice Address - Fax: | 856-327-4281 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-04-24 |
Last Update Date: | 2012-04-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NJ | 8819505 | Medicaid |