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General NPI Number Information
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NPI Number | 1316443567
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Entity Type | Organization
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Legal Business Name | ERICSON SUPPORT SERVICES LLC
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Dates
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Enumeration Date | 04/04/2018
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Last Update Date | 04/04/2018
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Provider Practice Location Address
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Address Line | 11 LA GORCE BLVD
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City | BURLINGTON
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State | NJ
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Zip | 08016-2903
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Country | US
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Telephone | 609-510-7509
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Fax |
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Provider Business Mailing Address
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Address Line | 11 LA GORCE BLVD
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City | BURLINGTON
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State | NJ
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Zip | 08016-2903
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Country | US
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Telephone | 609-510-7509
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | LISA M BORBOR
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Credential | BA
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Telephone | 609-510-7509
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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