=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396129649
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OCCUPATIONAL TRAINING CENTER OF BURLINGTON COUNTY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/16/2015
-----------------------------------------------------
Last Update Date | 02/28/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1570 BURLINGTON JACKSONVILLE RD
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-267-6677
-----------------------------------------------------
Fax | 609-265-8418
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 MANHATTAN DR
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08016-4120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-267-6677
-----------------------------------------------------
Fax | 609-267-8418
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. ISAAC LYNN MANNING
-----------------------------------------------------
Credential | BA
-----------------------------------------------------
Telephone | 609-267-6677
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320900000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------