Provider Demographics
NPI:1942481189
Name:COMUNIDAD UNIDA PARA REHABILITACION DE ADICTOS
Entity Type:Organization
Organization Name:COMUNIDAD UNIDA PARA REHABILITACION DE ADICTOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT&CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PLAZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-622-3570
Mailing Address - Street 1:35 LINCOLN PARK
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-2390
Mailing Address - Country:US
Mailing Address - Phone:973-622-3570
Mailing Address - Fax:973-622-1780
Practice Address - Street 1:73 LINCOLN PARK
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-2303
Practice Address - Country:US
Practice Address - Phone:973-622-3570
Practice Address - Fax:973-622-1780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03441900324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0988308-01Medicaid
NJD96709OtherMEDICAID UPIN
NJ7606001Medicaid