Healthcare Provider Details

I. General information

NPI: 1730698143
Provider Name (Legal Business Name): UNITY PLACE OF MONMOUTH COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2017
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 STEPHENSON AVE
FORT MONMOUTH NJ
07703-1518
US

IV. Provider business mailing address

821 WOODLAND DR
LAKEWOOD NJ
08701-3038
US

V. Phone/Fax

Practice location:
  • Phone: 848-208-2636
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: JERRY TISCHLER
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 347-242-6502