Provider Demographics
NPI:1881838779
Name:THE LESTER A. DRENK BEHAVIORAL HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:THE LESTER A. DRENK BEHAVIORAL HEALTH CENTER, INC.
Other - Org Name:THE DRENK CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CRISIS SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:NEFESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:WIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LSW
Authorized Official - Phone:609-835-6180
Mailing Address - Street 1:1289 ROUTE 38
Mailing Address - Street 2:
Mailing Address - City:HAINESPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:08036-2730
Mailing Address - Country:US
Mailing Address - Phone:609-267-5656
Mailing Address - Fax:609-267-8892
Practice Address - Street 1:218A SUNSET RD
Practice Address - Street 2:SCREENING, CRISIS & INFORMATION PROGRAM (SCIP)
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-1110
Practice Address - Country:US
Practice Address - Phone:609-835-6180
Practice Address - Fax:609-835-7962
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE DRENK CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ104100000X305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization