Provider Demographics
NPI:1801920830
Name:REHABILITATIVE ADOLESCENT PROGRAM, LLC
Entity type:Organization
Organization Name:REHABILITATIVE ADOLESCENT PROGRAM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:PRAJAKTA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HARSHE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LCADC, SAC
Authorized Official - Phone:609-704-5383
Mailing Address - Street 1:820 S WHITE HORSE PIKE
Mailing Address - Street 2:SUITE 2-B
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-2009
Mailing Address - Country:US
Mailing Address - Phone:609-704-5384
Mailing Address - Fax:609-561-0678
Practice Address - Street 1:820 S WHITE HORSE PIKE
Practice Address - Street 2:SUITE 2-B
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-2009
Practice Address - Country:US
Practice Address - Phone:609-704-5383
Practice Address - Fax:609-561-0678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00308100251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0035939Medicaid