Healthcare Provider Details

I. General information

NPI: 1366497356
Provider Name (Legal Business Name): CPC BEHAVIORAL HEALTHCARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 ROUTE 35
RED BANK NJ
07701-5920
US

IV. Provider business mailing address

10 INDUSTRIAL WAY E
EATONTOWN NJ
07724-3317
US

V. Phone/Fax

Practice location:
  • Phone: 732-842-2000
  • Fax: 732-224-0688
Mailing address:
  • Phone: 732-935-2220
  • Fax: 732-389-3207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN MANS
Title or Position: CEO
Credential: CPA
Phone: 732-935-2220