Healthcare Provider Details

I. General information

NPI: 1285952424
Provider Name (Legal Business Name): THE LESTER A. DRENK BEHAVIORAL HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 05/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 COVE RD
PENNSAUKEN NJ
08109-2409
US

IV. Provider business mailing address

1289 ROUTE 38 SUITE 203
HAINESPORT NJ
08036-2730
US

V. Phone/Fax

Practice location:
  • Phone: 609-267-5656
  • Fax:
Mailing address:
  • Phone: 609-267-5656
  • Fax: 609-265-1895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. CORY STOETZER
Title or Position: BILLING DIRECTOR
Credential:
Phone: 609-267-5656