Healthcare Provider Details

I. General information

NPI: 1720389083
Provider Name (Legal Business Name): URBAN ALTERNATIVE SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2010
Last Update Date: 03/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 W FRONT ST 2ND FLOOR
TRENTON NJ
08608-2013
US

IV. Provider business mailing address

15 W FRONT ST 2ND FLOOR
TRENTON NJ
08608-2013
US

V. Phone/Fax

Practice location:
  • Phone: 609-396-5931
  • Fax:
Mailing address:
  • Phone: 609-396-5931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1581742
License Number StateNJ

VIII. Authorized Official

Name: LARRY D DAVIS SR.
Title or Position: CEO
Credential: LCSW
Phone: 609-396-5931