Provider Demographics
NPI:1740679232
Name:SILVERGATE PREPARATORY SCHOOL LLC
Entity type:Organization
Organization Name:SILVERGATE PREPARATORY SCHOOL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-801-6700
Mailing Address - Street 1:981 RTE 22 STE 202
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-2946
Mailing Address - Country:US
Mailing Address - Phone:908-801-6700
Mailing Address - Fax:908-450-6223
Practice Address - Street 1:981 RTE 22 STE 202
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-2946
Practice Address - Country:US
Practice Address - Phone:908-801-6700
Practice Address - Fax:908-450-6223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty