Healthcare Provider Details

I. General information

NPI: 1952726846
Provider Name (Legal Business Name): GOD SQUAD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2014
Last Update Date: 02/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 MADISON AVE
LUMBERTON NJ
08048-2901
US

IV. Provider business mailing address

15 WHITEHAVEN DR
LUMBERTON NJ
08048-5010
US

V. Phone/Fax

Practice location:
  • Phone: 609-518-7082
  • Fax: 609-518-1191
Mailing address:
  • Phone: 732-213-6577
  • Fax: 609-518-1191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. ELLA L BROWN
Title or Position: EXECUTIVE DIRECTOR
Credential: D.MIN.
Phone: 732-213-6577