Provider Demographics
NPI:1336363514
Name:HUNTERDON PREVENTION RESOURCES
Entity Type:Organization
Organization Name:HUNTERDON PREVENTION RESOURCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:WIDICO
Authorized Official - Suffix:
Authorized Official - Credentials:MSW,CPS
Authorized Official - Phone:908-782-3909
Mailing Address - Street 1:4 WALTER E FORAN BLVD
Mailing Address - Street 2:SUITE 410
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-4664
Mailing Address - Country:US
Mailing Address - Phone:908-782-3909
Mailing Address - Fax:908-782-6025
Practice Address - Street 1:4 WALTER E FORAN BLVD
Practice Address - Street 2:SUITE 410
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-4664
Practice Address - Country:US
Practice Address - Phone:908-782-3909
Practice Address - Fax:908-782-6025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0117846Medicaid