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General NPI Number Information
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NPI Number | 1710033147
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Entity Type | Organization
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Legal Business Name | COMMUNITY CARE BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 06/03/2015
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Provider Practice Location Address
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Address Line | 131 ETHEL RD W
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City | PISCATAWAY
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State | NJ
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Zip | 08854-5900
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Country | US
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Telephone | 732-572-4666
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Fax |
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Provider Business Mailing Address
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Address Line | 1152 SAINT GEORGES AVE
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City | AVENEL
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State | NJ
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Zip | 07001-1269
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Country | US
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Telephone | 732-634-3331
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MARTIN COLEMAN
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Credential |
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Telephone | 732-634-3331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 910110305
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License Number State | NJ
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