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General NPI Number Information
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NPI Number | 1871487033
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Entity Type | Organization
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Legal Business Name | BLUECREST DETOX INC.
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Dates
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Enumeration Date | 06/04/2025
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | 6A MINNEAKONING RD
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City | FLEMINGTON
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State | NJ
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Zip | 08822
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Country | US
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Telephone | 973-298-5776
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Fax |
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Provider Business Mailing Address
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Address Line | 482 NOTCH RD
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City | WOODLAND PARK
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State | NJ
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Zip | 07424
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Country | US
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Telephone | 973-298-5776
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Fax |
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Authorized Official
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Title or Position | VP OPERATIONS
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Name | MICHELLE PAYNE
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Credential | LPC, LCADC
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Telephone | 551-777-3600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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