Healthcare Provider Details

I. General information

NPI: 1033490529
Provider Name (Legal Business Name): UNION ASSOCIATION OF THE CHILDREN'S HOME OF BURLINGTON COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2011
Last Update Date: 08/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 JACOBS CREEK RD
TITUSVILLE NJ
08560-1403
US

IV. Provider business mailing address

243 PINE ST
MOUNT HOLLY NJ
08060-2201
US

V. Phone/Fax

Practice location:
  • Phone: 609-267-1550
  • Fax: 609-261-5672
Mailing address:
  • Phone: 609-267-1550
  • Fax: 609-261-5672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number1100
License Number StateNJ

VIII. Authorized Official

Name: MR. ROY A. LEITSTEIN
Title or Position: EXECUTIVE DIRECTOR
Credential: M.S.
Phone: 609-267-1550