Provider Demographics
NPI:1700094638
Name:EXPLORE THE CHALLENGE
Entity Type:Organization
Organization Name:EXPLORE THE CHALLENGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:FATUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-893-5600
Mailing Address - Street 1:PO BOX 207
Mailing Address - Street 2:
Mailing Address - City:NEW LISBON
Mailing Address - State:NJ
Mailing Address - Zip Code:08064-0207
Mailing Address - Country:US
Mailing Address - Phone:609-893-5600
Mailing Address - Fax:609-893-3082
Practice Address - Street 1:30 TECUMSEH TRL
Practice Address - Street 2:
Practice Address - City:BROWNS MILLS
Practice Address - State:NJ
Practice Address - Zip Code:08015-6108
Practice Address - Country:US
Practice Address - Phone:609-893-5600
Practice Address - Fax:609-893-3082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00088900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty