Provider Demographics
NPI:1942735386
Name:MEDICAL HEALING CENTER FOR PAIN
Entity Type:Organization
Organization Name:MEDICAL HEALING CENTER FOR PAIN
Other - Org Name:MHCP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHANNIN
Authorized Official - Middle Name:DION
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-537-6427
Mailing Address - Street 1:204 GROVE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:WEST DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08086-2557
Mailing Address - Country:US
Mailing Address - Phone:856-537-6427
Mailing Address - Fax:856-384-2726
Practice Address - Street 1:204 GROVE AVE STE C
Practice Address - Street 2:
Practice Address - City:WEST DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08086-2557
Practice Address - Country:US
Practice Address - Phone:856-537-6427
Practice Address - Fax:856-384-2726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-24
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB092291002081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0646466Medicaid