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General NPI Number Information
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NPI Number | 1316564008
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Entity Type | Organization
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Legal Business Name | SURE BRIDGE
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Dates
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Enumeration Date | 06/29/2020
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Last Update Date | 06/29/2020
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Provider Practice Location Address
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Address Line | 900 EASTON AVE STE 26
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City | SOMERSET
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State | NJ
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Zip | 08873-1760
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Country | US
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Telephone | 732-347-6699
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 214
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City | KENDALL PARK
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State | NJ
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Zip | 08824-0214
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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 | CEO
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Name | FORTUNE NWACHUKWU
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Credential |
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Telephone | 732-343-5374
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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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