Healthcare Provider Details

I. General information

NPI: 1043852361
Provider Name (Legal Business Name): C-NETA BEHAVIORAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2019
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 WARREN ST STE 313
NEWARK NJ
07103-3568
US

IV. Provider business mailing address

211 WARREN ST STE 313
NEWARK NJ
07103-3568
US

V. Phone/Fax

Practice location:
  • Phone: 973-757-5100
  • Fax: 973-755-2002
Mailing address:
  • Phone: 973-757-5100
  • Fax: 973-755-2002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: OBIANUJU CHIEMELU
Title or Position: CEO
Credential: BCBA
Phone: 973-757-5100