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General NPI Number Information
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NPI Number | 1033279914
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Entity Type | Organization
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Legal Business Name | VISIONQUEST OF NEW JERSEY
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 07/09/2014
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Provider Practice Location Address
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Address Line | 108 ROUTE 72
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City | NEW LISBON
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State | NJ
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Zip | 08064-0370
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Country | US
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Telephone | 609-894-4826
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Fax | 609-894-8109
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Provider Business Mailing Address
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Address Line | 108 ROUTE 72
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City | NEW LISBON
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State | NJ
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Zip | 08064
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Country | US
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Telephone | 609-894-4826
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Fax | 609-894-8109
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Authorized Official
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Title or Position | VICE PRESIDENT - SERVICE DELIVERY
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Name | DR. BETH ANN ROSICA
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Credential | PH.D.
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Telephone | 610-486-2280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 0019666
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 1670
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License Number State | NJ
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