Healthcare Provider Details

I. General information

NPI: 1801307137
Provider Name (Legal Business Name): ASSOC. FOR RETARDED CITIZENS, INC. GLOUCESTER COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2017
Last Update Date: 10/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 NORTH DREXEL STREET
WOODBURY NJ
08096
US

IV. Provider business mailing address

1555 GATEWAY BOULEVARD
WEST DEPTFORD NJ
08096
US

V. Phone/Fax

Practice location:
  • Phone: 856-848-0664
  • Fax: 856-848-2164
Mailing address:
  • Phone: 856-848-8648
  • Fax: 856-848-7753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. ANA RIVERA
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 856-848-8648