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General NPI Number Information
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NPI Number | 1306604251
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Entity Type | Organization
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Legal Business Name | BETHEL BEHAVIORAL HEALTHCARE LLC
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Dates
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Enumeration Date | 03/06/2024
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Last Update Date | 03/06/2024
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Provider Practice Location Address
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Address Line | 765 ROUTE 70 E BLDG A
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City | MARLTON
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State | NJ
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Zip | 08053-2341
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Country | US
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Telephone | 201-790-4587
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Fax |
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Provider Business Mailing Address
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Address Line | 1710 EDWARD TER
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City | UNION
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State | NJ
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Zip | 07083-5106
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AUGUSTINA IKE
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Credential | APRN
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Telephone | 201-790-4587
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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