Healthcare Provider Details

I. General information

NPI: 1124363551
Provider Name (Legal Business Name): ESARC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2012
Last Update Date: 12/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 NAYLON AVE
LIVINGSTON NJ
07039-1005
US

IV. Provider business mailing address

123 NAYLON AVE
LIVINGSTON NJ
07039-1005
US

V. Phone/Fax

Practice location:
  • Phone: 973-535-1181
  • Fax: 973-433-0359
Mailing address:
  • Phone: 973-535-1181
  • Fax: 973-433-0359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: LINDA LUCAS
Title or Position: CEO
Credential:
Phone: 973-535-1181