=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023264462
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VENTNOR EDUCATIONAL COMMUNITY COMPLEX
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2008
-----------------------------------------------------
Last Update Date | 08/18/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 N LAFAYETTE AVE
-----------------------------------------------------
City | VENTNOR CITY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08406-1026
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-487-7900
-----------------------------------------------------
Fax | 609-487-1039
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 N LAFAYETTE AVE
-----------------------------------------------------
City | VENTNOR CITY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08406-1026
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-487-7900
-----------------------------------------------------
Fax | 609-487-1039
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF SPECIAL SERVICES
-----------------------------------------------------
Name | MRS. JOLIE TRABIN
-----------------------------------------------------
Credential | MSW
-----------------------------------------------------
Telephone | 609-487-7900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number | 251300000X
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------