Healthcare Provider Details

I. General information

NPI: 1669007225
Provider Name (Legal Business Name): ANCHOR BEHAVIORAL SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2020
Last Update Date: 03/04/2020
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 MAIN ST STE 310
WEST ORANGE NJ
07052-5333
US

IV. Provider business mailing address

PO BOX 3111
WEST ORANGE NJ
07052-3061
US

V. Phone/Fax

Practice location:
  • Phone: 862-233-7552
  • Fax:
Mailing address:
  • Phone: 862-233-7552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ASLAM ALI
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 862-233-7552