Healthcare Provider Details

I. General information

NPI: 1770611659
Provider Name (Legal Business Name): CPC BEHAVIORAL HEALTHCARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 STATE ROUTE 35
RED BANK NJ
07701-5920
US

IV. Provider business mailing address

10 INDUSTRIAL WAY E
EATONTOWN NJ
07724-3332
US

V. Phone/Fax

Practice location:
  • Phone: 732-842-2000
  • Fax:
Mailing address:
  • Phone: 732-935-2220
  • Fax:

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