Healthcare Provider Details

I. General information

NPI: 1033279914
Provider Name (Legal Business Name): VISIONQUEST OF NEW JERSEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 ROUTE 72
NEW LISBON NJ
08064-0370
US

IV. Provider business mailing address

108 ROUTE 72
NEW LISBON NJ
08064
US

V. Phone/Fax

Practice location:
  • Phone: 609-894-4826
  • Fax: 609-894-8109
Mailing address:
  • Phone: 609-894-4826
  • Fax: 609-894-8109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number0019666
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number1670
License Number StateNJ

VIII. Authorized Official

Name: DR. BETH ANN ROSICA
Title or Position: VICE PRESIDENT - SERVICE DELIVERY
Credential: PH.D.
Phone: 610-486-2280