Provider Demographics
NPI:1962661009
Name:UNION ASSOCIATION OF THE CHILDRENS HOME OF BURLINGTON COUNTY
Entity Type:Organization
Organization Name:UNION ASSOCIATION OF THE CHILDRENS HOME OF BURLINGTON COUNTY
Other - Org Name:THE CHILDRENS HOME OF BURLINGTON COUNTY
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEITSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-267-1550
Mailing Address - Street 1:243 PINE ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-2201
Mailing Address - Country:US
Mailing Address - Phone:609-267-1550
Mailing Address - Fax:609-261-5672
Practice Address - Street 1:243 PINE ST
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060-2201
Practice Address - Country:US
Practice Address - Phone:609-267-1550
Practice Address - Fax:609-261-5672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1100322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0131539Medicaid