Healthcare Provider Details

I. General information

NPI: 1154775252
Provider Name (Legal Business Name): MONMOUTH COUNTY BOARD OF RECREATION COMMISSIONERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2016
Last Update Date: 04/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 NEWMAN SPRINGS RD
LINCROFT NJ
07738-1628
US

IV. Provider business mailing address

805 NEWMAN SPRINGS RD
LINCROFT NJ
07738-1628
US

V. Phone/Fax

Practice location:
  • Phone: 732-460-1167
  • Fax: 732-460-1168
Mailing address:
  • Phone: 732-460-1167
  • Fax: 732-460-1168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES TRUNCER
Title or Position: SECRETARY-DIRECTOR
Credential:
Phone: 732-842-4000