Healthcare Provider Details

I. General information

NPI: 1831618123
Provider Name (Legal Business Name): TRENTON HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2017
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 NEW YORK AVE
TRENTON NJ
08638-3913
US

IV. Provider business mailing address

PO BOX 3716
TRENTON NJ
08629-0716
US

V. Phone/Fax

Practice location:
  • Phone: 609-858-7850
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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 OF PATIENT ACCOUNTS
Credential:
Phone: 610-994-2968