Provider Demographics
NPI:1396515680
Name:SANDERS, CATHERINE C (HEALTH CARE)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:C
Last Name:SANDERS
Suffix:
Gender:F
Credentials:HEALTH CARE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:683 S 14TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-1410
Mailing Address - Country:US
Mailing Address - Phone:862-275-0971
Mailing Address - Fax:
Practice Address - Street 1:683 S 14TH ST FL 1
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-1410
Practice Address - Country:US
Practice Address - Phone:868-275-9081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities