Healthcare Provider Details

I. General information

NPI: 1487034757
Provider Name (Legal Business Name): YOUTH CONSULTATION SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2015
Last Update Date: 06/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 AMWELL RD
SOMERSET NJ
08873-5216
US

IV. Provider business mailing address

284 BROADWAY
NEWARK NJ
07104-4003
US

V. Phone/Fax

Practice location:
  • Phone: 973-482-8411
  • Fax:
Mailing address:
  • Phone: 973-482-8411
  • Fax: 973-482-2907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberECS382A
License Number StateNJ

VIII. Authorized Official

Name: MR. RICHARD MINGOIA
Title or Position: PRESIDENT CEO
Credential:
Phone: 973-482-8411