Provider Demographics
NPI:1902180037
Name:THE KINTOCK GROUP OF NEW JERSEY, INC.
Entity Type:Organization
Organization Name:THE KINTOCK GROUP OF NEW JERSEY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEBARRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-687-1336
Mailing Address - Street 1:2010 RENAISSANCE BLVD
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-2746
Mailing Address - Country:US
Mailing Address - Phone:610-687-1336
Mailing Address - Fax:610-687-1428
Practice Address - Street 1:610 PEMBERTON BROWNS MILLS RD
Practice Address - Street 2:
Practice Address - City:PEMBERTON
Practice Address - State:NJ
Practice Address - Zip Code:08068-1537
Practice Address - Country:US
Practice Address - Phone:609-726-7155
Practice Address - Fax:609-894-8964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1000085324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility