Healthcare Provider Details

I. General information

NPI: 1518376813
Provider Name (Legal Business Name): THERAPEUTIC ALTERNATIVES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2014
Last Update Date: 08/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

869 GARRISON RD
MONROEVILLE NJ
08343-4513
US

IV. Provider business mailing address

236 W ROUTE 38 SUITE 100
MOORESTOWN NJ
08057-3276
US

V. Phone/Fax

Practice location:
  • Phone: 856-642-9090
  • Fax: 856-642-9303
Mailing address:
  • Phone: 856-642-9090
  • Fax: 856-642-9303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number4204
License Number StateNJ

VIII. Authorized Official

Name: SUSAN BUCHWALD
Title or Position: CEO
Credential:
Phone: 856-642-9090