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General NPI Number Information
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NPI Number | 1164913786
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Entity Type | Organization
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Legal Business Name | THE PASSION CARE CENTER
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Dates
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Enumeration Date | 05/21/2018
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Last Update Date | 05/21/2018
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Provider Practice Location Address
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Address Line | 187 FAYETTE ST
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City | PERTH AMBOY
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State | NJ
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Zip | 08861-4140
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Country | US
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Telephone | 267-909-8264
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Fax | 215-525-0272
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Provider Business Mailing Address
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Address Line | 187 FAYETTE ST
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City | PERTH AMBOY
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State | NJ
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Zip | 08861-4140
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Country | US
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Telephone | 267-909-8264
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Fax | 215-525-0272
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Authorized Official
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Title or Position | ACCOUNT MANAGER
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Name | OMAR RILEY
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Credential |
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Telephone | 267-909-8264
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State | NJ
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