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General NPI Number Information
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NPI Number | 1760729305
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Entity Type | Organization
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Legal Business Name | GOD SQUAD, INC.
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Dates
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Enumeration Date | 01/15/2013
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Last Update Date | 01/15/2013
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Provider Practice Location Address
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Address Line | 15 WHITEHAVEN DR
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City | LUMBERTON
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State | NJ
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Zip | 08048-5010
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Country | US
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Telephone | 732-213-6577
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Fax | 609-518-1191
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Provider Business Mailing Address
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Address Line | 15 WHITEHAVEN DR
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City | LUMBERTON
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State | NJ
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Zip | 08048-5010
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Country | US
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Telephone | 609-518-7082
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. ELLA BROWN
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Credential | DOC. OF MIN.
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Telephone | 732-213-6577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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