Healthcare Provider Details

I. General information

NPI: 1780341198
Provider Name (Legal Business Name): AZURE BEHAVIORAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2021
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HORIZON CENTER BLVD, SUITE #117
HAMILTON TOWNSHIP NJ
08691
US

IV. Provider business mailing address

100 HORIZON CENTER BLVD #117
HAMILTON TOWNSHIP NJ
08691-1910
US

V. Phone/Fax

Practice location:
  • Phone: 732-357-7188
  • Fax:
Mailing address:
  • Phone: 732-357-7188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MERCY UGBOAJA
Title or Position: PROVIDER
Credential: NP
Phone: 732-357-7188