Provider Demographics
NPI:1720502792
Name:ROLA BEHAVIORAL SERVICES LLC
Entity Type:Organization
Organization Name:ROLA BEHAVIORAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BOLANLE
Authorized Official - Middle Name:
Authorized Official - Last Name:POPOOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-895-4733
Mailing Address - Street 1:1676 N OLDEN AVE BLDG 1
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08638-3209
Mailing Address - Country:US
Mailing Address - Phone:609-235-1610
Mailing Address - Fax:
Practice Address - Street 1:1676 NORTH OLDEN AVE
Practice Address - Street 2:BLDG 1
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08638
Practice Address - Country:US
Practice Address - Phone:609-235-1610
Practice Address - Fax:609-235-1610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-01
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00494100163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Single Specialty