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General NPI Number Information
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NPI Number | 1700942547
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Entity Type | Organization
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Legal Business Name | ST. PETER'S ORPHANAGE, INC.
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 170 DIAMOND SPRING RD
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City | DENVILLE
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State | NJ
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Zip | 07834-2910
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Country | US
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Telephone | 973-627-0212
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Fax |
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Provider Business Mailing Address
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Address Line | 170 DIAMOND SPRING RD
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City | DENVILLE
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State | NJ
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Zip | 07834-2910
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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 | ADMINISTRATIVE ASSISTANT
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Name | MICHELE SQUEO
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Credential |
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Telephone | 973-627-0212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | 1620
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License Number State | NJ
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