=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205040169
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW DIRECTIONS BEHAVIORAL HEALTH CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2007
-----------------------------------------------------
Last Update Date | 08/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9 LINCOLN PARK
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07102-2301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-242-6599
-----------------------------------------------------
Fax | 973-242-1976
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9 LINCOLN PARK
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07102-2301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-242-6599
-----------------------------------------------------
Fax | 973-242-1976
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. ROY HARGROVE JR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 973-242-6599
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number | 100100105
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QR0405X
-----------------------------------------------------
Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
-----------------------------------------------------
License Number | 23255
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------