Healthcare Provider Details

I. General information

NPI: 1043601099
Provider Name (Legal Business Name): THERAPEUTIC ALTERNATIVES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2015
Last Update Date: 02/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

448 PARKVIEW DR
MOUNT HOLLY NJ
08060-1253
US

IV. Provider business mailing address

236 W ROUTE 38
MOORESTOWN NJ
08057-3276
US

V. Phone/Fax

Practice location:
  • Phone: 856-642-9090
  • Fax:
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 Number
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNJ

VIII. Authorized Official

Name: SUSAN C BUCHWALD
Title or Position: C E O
Credential:
Phone: 856-642-9090