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General NPI Number Information
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NPI Number | 1760782957
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Entity Type | Organization
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Legal Business Name | HARMONY PLACE DAS PROGRAM LLC
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Dates
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Enumeration Date | 10/22/2010
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Last Update Date | 10/22/2010
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Provider Practice Location Address
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Address Line | 7070 KAIGHNS AVE # A
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City | PENNSAUKEN
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State | NJ
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Zip | 08109-4421
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Country | US
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Telephone | 732-364-4466
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Fax | 732-364-7725
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Provider Business Mailing Address
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Address Line | 776 S LAKE DR
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City | LAKEWOOD
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State | NJ
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Zip | 08701-3031
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Country | US
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Telephone | 732-364-4466
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Fax | 732-364-7725
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Authorized Official
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Title or Position | MEMBER
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Name | STEVEN LANGERT
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Credential |
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Telephone | 732-364-4466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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