Healthcare Provider Details

I. General information

NPI: 1154857472
Provider Name (Legal Business Name): UNION ASSOCIATION OF THE CHILDREN'S HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2017
Last Update Date: 05/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 COLLEGE RD SUITE 101
DOVER DE
19904-6506
US

IV. Provider business mailing address

1289 ROUTE 38 STE 203
HAINESPORT NJ
08036-2730
US

V. Phone/Fax

Practice location:
  • Phone: 609-288-5656
  • Fax:
Mailing address:
  • Phone: 609-288-5656
  • Fax: 609-265-1895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNJ

VIII. Authorized Official

Name: MELINDA OTA
Title or Position: ACTING CFO
Credential:
Phone: 609-267-5656