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General NPI Number Information
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NPI Number | 1104184506
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Entity Type | Organization
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Legal Business Name | IEP YOUTH SERVICES, INC.
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Dates
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Enumeration Date | 04/24/2012
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Last Update Date | 04/24/2012
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Provider Practice Location Address
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Address Line | 75 W MAIN ST
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City | FREEHOLD
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State | NJ
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Zip | 07728-2114
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Country | US
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Telephone | 732-431-2663
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Fax | 732-409-3634
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Provider Business Mailing Address
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Address Line | 75 W MAIN ST
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City | FREEHOLD
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State | NJ
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Zip | 07728-2114
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Country | US
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Telephone | 732-431-2663
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Fax | 732-409-3634
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Authorized Official
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Title or Position | CFO
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Name | SHARON GOLDMAN
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Credential | CPA
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Telephone | 732-431-2663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | 4140
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License Number State | NJ
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