Provider Demographics
NPI:1982813531
Name:PILGRIMAGE OUTREACH,INC. ( FBHSP )
Entity Type:Organization
Organization Name:PILGRIMAGE OUTREACH,INC. ( FBHSP )
Other - Org Name:PILGRIMAGE OUTREACH,INC. ( FBHSP )
Other - Org Type:Other Name
Authorized Official - Title/Position:C.E.O.SENIOR COUNSELOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:NATIONAL PLC
Authorized Official - Phone:973-851-5886
Mailing Address - Street 1:449 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07522-1937
Mailing Address - Country:US
Mailing Address - Phone:973-389-2165
Mailing Address - Fax:973-389-2895
Practice Address - Street 1:449 UNION AVE
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07522-1937
Practice Address - Country:US
Practice Address - Phone:973-389-2165
Practice Address - Fax:973-389-2895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)