Provider Demographics
NPI:1952906190
Name:CENTER FOR AFRICAN AMERICAN HEALTH DISPARITIES EDUCATION & RESEARCH
Entity Type:Organization
Organization Name:CENTER FOR AFRICAN AMERICAN HEALTH DISPARITIES EDUCATION & RESEARCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, CCP
Authorized Official - Phone:609-802-8476
Mailing Address - Street 1:125 N HARTFORD AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08401-3547
Mailing Address - Country:US
Mailing Address - Phone:609-802-8476
Mailing Address - Fax:
Practice Address - Street 1:125 N HARTFORD AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-3547
Practice Address - Country:US
Practice Address - Phone:609-802-8476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-04
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
No1744R1102XOther Service ProvidersSpecialistResearch StudyGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No405300000XOther Service ProvidersPrevention ProfessionalGroup - Multi-Specialty