Healthcare Provider Details

I. General information

NPI: 1568977429
Provider Name (Legal Business Name): COMPREHENSIVE BEHAVIORAL HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2017
Last Update Date: 12/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 E SALEM ST
HACKENSACK NJ
07601-7427
US

IV. Provider business mailing address

25 E SALEM ST
HACKENSACK NJ
07601-7427
US

V. Phone/Fax

Practice location:
  • Phone: 201-646-0333
  • Fax: 201-296-6319
Mailing address:
  • Phone: 201-646-0333
  • Fax: 201-296-6319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier4549805
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: MS. DANA JAWORSKI
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 201-935-3322