Healthcare Provider Details

I. General information

NPI: 1700942547
Provider Name (Legal Business Name): ST. PETER'S ORPHANAGE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 DIAMOND SPRING RD
DENVILLE NJ
07834-2910
US

IV. Provider business mailing address

170 DIAMOND SPRING RD
DENVILLE NJ
07834-2910
US

V. Phone/Fax

Practice location:
  • Phone: 973-627-0212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number1620
License Number StateNJ

VIII. Authorized Official

Name: MICHELE SQUEO
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 973-627-0212