Healthcare Provider Details

I. General information

NPI: 1447089545
Provider Name (Legal Business Name): SANCTUARY WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 MAIN ST
MADISON NJ
07940-2237
US

IV. Provider business mailing address

PO BOX 658
CHATHAM NJ
07928-0658
US

V. Phone/Fax

Practice location:
  • Phone: 973-314-9040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANITA BOBBA
Title or Position: DIRECTOR OF BUSINESS OPERATIONS
Credential:
Phone: 973-314-9040