Provider Demographics
NPI:1457762080
Name:IMMEDIATE CARE WOMEN'S PSYCHIATRIC CENTER, LLC
Entity Type:Organization
Organization Name:IMMEDIATE CARE WOMEN'S PSYCHIATRIC CENTER, LLC
Other - Org Name:ICWPC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SRINIVASA
Authorized Official - Middle Name:K
Authorized Official - Last Name:RAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-335-9909
Mailing Address - Street 1:22 HILL RD
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-1078
Mailing Address - Country:US
Mailing Address - Phone:973-335-8030
Mailing Address - Fax:973-695-1049
Practice Address - Street 1:26 HILL RD
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-1001
Practice Address - Country:US
Practice Address - Phone:973-335-9909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-16
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health