Provider Demographics
NPI:1952070336
Name:EMERALD BEHAVIORAL HEALTHCARE LLC
Entity Type:Organization
Organization Name:EMERALD BEHAVIORAL HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:KREISWIRTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-267-0473
Mailing Address - Street 1:258 PINEDGE DR
Mailing Address - Street 2:
Mailing Address - City:WEST BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08091-9218
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:258 PINEDGE DR
Practice Address - Street 2:
Practice Address - City:WEST BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08091-9218
Practice Address - Country:US
Practice Address - Phone:856-753-8111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMERALD BEHAVIORAL HEALTHCARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center