Provider Demographics
NPI:1942484720
Name:LONG BEACH ISLAND COMMUNITY CENTER
Entity Type:Organization
Organization Name:LONG BEACH ISLAND COMMUNITY CENTER
Other - Org Name:ST. FRANCIS COMMUNITY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:T
Authorized Official - Last Name:HAZLETT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCSW
Authorized Official - Phone:609-494-8861
Mailing Address - Street 1:4700 LONG BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08008-3926
Mailing Address - Country:US
Mailing Address - Phone:609-494-8861
Mailing Address - Fax:609-494-1882
Practice Address - Street 1:4700 LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08008-3926
Practice Address - Country:US
Practice Address - Phone:609-494-8861
Practice Address - Fax:609-494-1882
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LONG BEACH ISLAND COMMUNITY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health