Healthcare Provider Details

I. General information

NPI: 1245630524
Provider Name (Legal Business Name): EAST COAST BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2014
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 MOUNTAIN RD
HAMBURG NJ
07419-9649
US

IV. Provider business mailing address

PO BOX 458
HAMBURG NJ
07419-0458
US

V. Phone/Fax

Practice location:
  • Phone: 862-364-4118
  • Fax:
Mailing address:
  • Phone: 862-364-4118
  • Fax: 973-928-8124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: MR. ALLEN W RUDE III
Title or Position: OWNER/OPERATOR
Credential: LAC, LAPC
Phone: 862-364-4118