Healthcare Provider Details

I. General information

NPI: 1780178707
Provider Name (Legal Business Name): ATLANTIC COMMUNITY CHARTER SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2018
Last Update Date: 06/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 SOUTH NEW YORK RD
GALLOWAY NJ
08205
US

IV. Provider business mailing address

112 SOUTH NEW YORK RD
GALLOWAY NJ
08205
US

V. Phone/Fax

Practice location:
  • Phone: 609-428-4300
  • Fax: 609-652-4080
Mailing address:
  • Phone: 609-428-4300
  • Fax: 609-652-4080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN DUGAN
Title or Position: LEAD PERSON
Credential:
Phone: 609-428-4300