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General NPI Number Information
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NPI Number | 1396282778
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Entity Type | Organization
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Legal Business Name | BHMG-CORPORATE CARE
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Dates
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Enumeration Date | 01/24/2017
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Last Update Date | 01/24/2017
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Provider Practice Location Address
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Address Line | 101 PROSPECT ST SUITE 120
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City | LAKEWOOD
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State | NJ
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Zip | 08701-5020
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Country | US
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Telephone | 732-886-4795
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Fax |
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Provider Business Mailing Address
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Address Line | 101 PROSPECT ST SUITE 120
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City | LAKEWOOD
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State | NJ
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Zip | 08701-5020
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Country | US
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Telephone | 732-886-4795
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATIVE DIRECTOR
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Name | ELAINE BLANDINO
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Credential |
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Telephone | 732-886-4795
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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