Provider Demographics
NPI:1851788426
Name:COLLINGSWOOD CEREBRAL PALSY ADULT ACTIVITY CENTER
Entity Type:Organization
Organization Name:COLLINGSWOOD CEREBRAL PALSY ADULT ACTIVITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:SLATTERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-858-4984
Mailing Address - Street 1:431 S PARK DR
Mailing Address - Street 2:
Mailing Address - City:COLLINGSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-1407
Mailing Address - Country:US
Mailing Address - Phone:856-858-4984
Mailing Address - Fax:856-858-5225
Practice Address - Street 1:431 S PARK DR
Practice Address - Street 2:
Practice Address - City:COLLINGSWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08108-1407
Practice Address - Country:US
Practice Address - Phone:856-858-4984
Practice Address - Fax:856-858-5225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services