Healthcare Provider Details

I. General information

NPI: 1740340371
Provider Name (Legal Business Name): TRIPLE C HOUSING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 03/21/2022
Certification Date: 03/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 ROUTE 130 STE 201
NORTH BRUNSWICK NJ
08902-3145
US

IV. Provider business mailing address

1520 ROUTE 130 STE 201
NORTH BRUNSWICK NJ
08902-3145
US

V. Phone/Fax

Practice location:
  • Phone: 732-658-6636
  • Fax: 732-658-6642
Mailing address:
  • Phone: 732-658-6636
  • Fax: 732-658-6642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number20108M080240
License Number StateNJ

VIII. Authorized Official

Name: MRS. LESLIE STIVALE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 732-297-5840