Healthcare Provider Details

I. General information

NPI: 1003282971
Provider Name (Legal Business Name): ASSOC. FOR RETARDED CITIZENS, INC. GLOUCESTER COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2015
Last Update Date: 08/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 TUCKAHOE ROAD CHESTNUT RIDGE ATS 1
SEWELL NJ
08080
US

IV. Provider business mailing address

1555 GATEWAY BOULEVARD
WEST DEPTFORD NJ
08096
US

V. Phone/Fax

Practice location:
  • Phone: 856-629-1086
  • Fax: 856-629-5442
Mailing address:
  • Phone: 856-848-8648
  • Fax: 856-848-7753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. ANA RIVERA
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 856-848-8648