Healthcare Provider Details

I. General information

NPI: 1093822264
Provider Name (Legal Business Name): DAYTOP VILLAGE OF NJ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 09/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 W MAIN ST
MENDHAM NJ
07945-1230
US

IV. Provider business mailing address

PO BOX 310
MENDHAM NJ
07945-1230
US

V. Phone/Fax

Practice location:
  • Phone: 973-543-5656
  • Fax: 973-543-5273
Mailing address:
  • Phone: 862-260-9460
  • Fax: 862-260-9461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License NumberAS0002
License Number StateNJ

VIII. Authorized Official

Name: MR. STEPHEN SCRAPE
Title or Position: DIRECTOR OF FINANCE & CONTROLLER
Credential:
Phone: 862-260-9460