Healthcare Provider Details

I. General information

NPI: 1801602537
Provider Name (Legal Business Name): PEACE JOURNEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2024
Last Update Date: 12/07/2024
Certification Date: 12/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 PATTON DR APT A
BLOOMFIELD NJ
07003-5283
US

IV. Provider business mailing address

21 PATTON DR APT A
BLOOMFIELD NJ
07003-5283
US

V. Phone/Fax

Practice location:
  • Phone: 908-803-9550
  • Fax:
Mailing address:
  • Phone: 908-803-9550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. FAJR SALAAM-GOODWIN
Title or Position: OWNER/SOCIAL WORKER
Credential: LCSW
Phone: 908-803-9550