Provider Demographics
NPI:1023264462
Name:VENTNOR EDUCATIONAL COMMUNITY COMPLEX
Entity type:Organization
Organization Name:VENTNOR EDUCATIONAL COMMUNITY COMPLEX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SPECIAL SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRABIN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:609-487-7900
Mailing Address - Street 1:400 N LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:VENTNOR CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08406-1026
Mailing Address - Country:US
Mailing Address - Phone:609-487-7900
Mailing Address - Fax:609-487-1039
Practice Address - Street 1:400 N LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:VENTNOR CITY
Practice Address - State:NJ
Practice Address - Zip Code:08406-1026
Practice Address - Country:US
Practice Address - Phone:609-487-7900
Practice Address - Fax:609-487-1039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ251300000X251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ251300000XMedicaid