Healthcare Provider Details

I. General information

NPI: 1891025672
Provider Name (Legal Business Name): SHORE BEHAVIORAL HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2009
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 NEW RD STE 62
LINWOOD NJ
08221-2025
US

IV. Provider business mailing address

199 NEW RD STE 62
LINWOOD NJ
08221-2025
US

V. Phone/Fax

Practice location:
  • Phone: 609-226-1261
  • Fax: 888-487-0032
Mailing address:
  • Phone: 609-226-1261
  • Fax: 888-487-0032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00309400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05007700
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA07531400
License Number StateNJ

VIII. Authorized Official

Name: DR. INUA A. MOMODU
Title or Position: MEDICAL DIRECTOR
Credential: M.D., M.P.H.
Phone: 609-402-5010