Healthcare Provider Details

I. General information

NPI: 1447810155
Provider Name (Legal Business Name): TRENTON HEALTHCARE, LLC (WORKFIRST ONLY)
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2019
Last Update Date: 06/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 NEW YORK AVE
TRENTON NJ
08638-3913
US

IV. Provider business mailing address

2701 RENAISSANCE BLVD FL 4
KING OF PRUSSIA PA
19406-2781
US

V. Phone/Fax

Practice location:
  • Phone: 609-393-8000
  • Fax: 609-393-8020
Mailing address:
  • Phone: 484-803-9663
  • Fax: 484-393-4096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State

VIII. Authorized Official

Name: MARK GALLIHUE
Title or Position: DIRECTOR, PATIENT ACCOUNTS
Credential:
Phone: 610-994-2968