Healthcare Provider Details

I. General information

NPI: 1366826646
Provider Name (Legal Business Name): OCCUPATIONAL TRAINING CENTER OF BURLINGTON COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2015
Last Update Date: 06/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 NEWTOWN LN
WILLINGBORO NJ
08046-1912
US

IV. Provider business mailing address

2 MANHATTAN DR
BURLINGTON NJ
08016-4120
US

V. Phone/Fax

Practice location:
  • Phone: 609-267-6677
  • Fax: 609-265-8418
Mailing address:
  • Phone: 609-267-6677
  • Fax: 609-265-8418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberGH2274
License Number StateNJ

VIII. Authorized Official

Name: JEFFREY LYNN HAINES
Title or Position: CEO
Credential: MA
Phone: 609-267-6677