Healthcare Provider Details

I. General information

NPI: 1750149043
Provider Name (Legal Business Name): COMBS & LEVY CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1479 KAIGHN AVE
CAMDEN NJ
08103-2935
US

IV. Provider business mailing address

1479 KAIGHN AVE
CAMDEN NJ
08103-2935
US

V. Phone/Fax

Practice location:
  • Phone: 856-425-2442
  • Fax:
Mailing address:
  • Phone: 856-425-2442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. LEVI COMBS III
Title or Position: CEO
Credential:
Phone: 856-425-2442