Healthcare Provider Details

I. General information

NPI: 1184771768
Provider Name (Legal Business Name): RUTGERS-UNIVERSITY BEHAVIORAL HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

671 HOES LN
PISCATAWAY NJ
08854-5627
US

IV. Provider business mailing address

671 HOES LN P.O. BOX 1392
PISCATAWAY NJ
08854-5627
US

V. Phone/Fax

Practice location:
  • Phone: 732-235-3493
  • Fax: 732-235-2101
Mailing address:
  • Phone: 732-235-3493
  • Fax: 732-235-2101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number20101M040140
License Number StateNJ

VIII. Authorized Official

Name: MR. FRANCIS X. COLFORD
Title or Position: VICE PRESIDENT, FINANCE & TREASURER
Credential:
Phone: 732-235-5940