Healthcare Provider Details

I. General information

NPI: 1063699213
Provider Name (Legal Business Name): OUR PLACE PARIAL CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 W LANDIS AVE
VINELAND NJ
08360-8143
US

IV. Provider business mailing address

134 HEARTH CT E
LAKEWOOD NJ
08701-4133
US

V. Phone/Fax

Practice location:
  • Phone: 848-448-5483
  • Fax:
Mailing address:
  • Phone: 848-448-5483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SANDRA TISCHLER
Title or Position: CFO
Credential:
Phone: 848-448-5483