Healthcare Provider Details

I. General information

NPI: 1255439287
Provider Name (Legal Business Name): CATHOLIC COMMUNITY SERVICES MT CARMEL GUILD OF ARCH OF NEWARK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 03/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 RAYMOND BLVD
NEWARK NJ
07102-4168
US

IV. Provider business mailing address

1160 RAYMOND BLVD
NEWARK NJ
07102-4168
US

V. Phone/Fax

Practice location:
  • Phone: 973-596-4103
  • Fax: 973-596-4101
Mailing address:
  • Phone: 973-596-4103
  • Fax: 973-596-3828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number StateNJ

VIII. Authorized Official

Name: MR. JOHN W WESTERVELT
Title or Position: CFO/VP SUPPORT SERVICES
Credential: BS
Phone: 973-596-3984