Healthcare Provider Details

I. General information

NPI: 1134506355
Provider Name (Legal Business Name): ABSOLUTE HAVEN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2015
Last Update Date: 04/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 S WHITE HORSE PIKE SUITE A
WATERFORD WORKS NJ
08089-2222
US

IV. Provider business mailing address

182 PUMP BRANCH RD PO BOX 482
WATERFORD WORKS NJ
08089-2430
US

V. Phone/Fax

Practice location:
  • Phone: 856-753-9993
  • Fax:
Mailing address:
  • Phone: 856-753-9993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number32WU00002200
License Number StateNJ

VIII. Authorized Official

Name: JENNIFER LAURYL JENNINGS
Title or Position: OWNER
Credential: LMT
Phone: 856-753-9993