Provider Demographics
NPI:1770911471
Name:EXPERIENCED SUPPORT COORDINATION LLC
Entity type:Organization
Organization Name:EXPERIENCED SUPPORT COORDINATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:LENCOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-581-1614
Mailing Address - Street 1:108 JONI AVE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-3641
Mailing Address - Country:US
Mailing Address - Phone:609-581-1614
Mailing Address - Fax:
Practice Address - Street 1:108 JONI AVE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08690-3641
Practice Address - Country:US
Practice Address - Phone:609-581-1614
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251X00000X
NJ251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251X00000XAgenciesSupports Brokerage