Provider Demographics
NPI:1912024639
Name:NUEVA VIDA BEHAVIORAL HEALTH CENTER
Entity Type:Organization
Organization Name:NUEVA VIDA BEHAVIORAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:S
Authorized Official - Last Name:TAVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-338-1995
Mailing Address - Street 1:427 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08102-1525
Mailing Address - Country:US
Mailing Address - Phone:856-338-1995
Mailing Address - Fax:856-338-0247
Practice Address - Street 1:427 MARKET ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08102-1525
Practice Address - Country:US
Practice Address - Phone:856-338-1995
Practice Address - Fax:856-338-0247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7995709Medicaid