=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174663116
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAYTOP VILLAGE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2007
-----------------------------------------------------
Last Update Date | 02/06/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9 HARDING HWY
-----------------------------------------------------
City | PITTSGROVE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08318-4401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-358-4111
-----------------------------------------------------
Fax | 856-358-4120
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9 HARDING HIGHWAY
-----------------------------------------------------
City | PITTSGROVE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-358-4111
-----------------------------------------------------
Fax | 856-358-4120
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. ERIACH FOX
-----------------------------------------------------
Credential | MA
-----------------------------------------------------
Telephone | 856-358-4111
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number | 1000005
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------