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General NPI Number Information
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NPI Number | 1629122601
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Entity Type | Organization
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Legal Business Name | MORNING GLORY BEHAVIORAL HEALTH PARTIAL CARE PROGRAM LLC
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 01/18/2010
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Provider Practice Location Address
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Address Line | 3443 HWY 66
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City | NEPTUNE
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State | NJ
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Zip | 07753-2764
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Country | US
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Telephone | 732-918-9905
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Fax | 732-918-9907
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Provider Business Mailing Address
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Address Line | 3443 HWY 66
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City | NEPTUNE
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State | NJ
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Zip | 07753-2764
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Country | US
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Telephone | 732-918-9905
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Fax | 732-918-9907
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. COLLEEN BAILEY
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Credential |
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Telephone | 732-918-9905
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 10120-01-05
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License Number State | NJ
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