Healthcare Provider Details

I. General information

NPI: 1639443112
Provider Name (Legal Business Name): TJYGCP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2012
Last Update Date: 10/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 CLIFFWOOD AVE SUITE B
CLIFFWOOD NJ
07721-1131
US

IV. Provider business mailing address

4142 OGLETOWN STANTON RD SUITE 251
NEWARK DE
19713-4169
US

V. Phone/Fax

Practice location:
  • Phone: 888-609-3396
  • Fax: 800-609-3396
Mailing address:
  • Phone: 888-609-3396
  • Fax: 800-604-7209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: LAVONNE HENDERSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 888-609-3396