Provider Demographics
NPI:1740340371
Name:TRIPLE C HOUSING, INC
Entity type:Organization
Organization Name:TRIPLE C HOUSING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STIVALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-297-5840
Mailing Address - Street 1:1520 ROUTE 130 STE 201
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-3145
Mailing Address - Country:US
Mailing Address - Phone:732-658-6636
Mailing Address - Fax:732-658-6642
Practice Address - Street 1:1520 ROUTE 130 STE 201
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-3145
Practice Address - Country:US
Practice Address - Phone:732-658-6636
Practice Address - Fax:732-658-6642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ20108M080240320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0085707Medicaid