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General NPI Number Information
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NPI Number | 1902127848
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Entity Type | Organization
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Legal Business Name | IRVINGTON FAMILY SERVICES, INC.
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Dates
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Enumeration Date | 06/15/2010
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Last Update Date | 06/15/2010
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Provider Practice Location Address
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Address Line | 660 S 21ST ST
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City | IRVINGTON
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State | NJ
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Zip | 07111-4109
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Country | US
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Telephone | 973-372-4433
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Fax | 973-372-4411
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Provider Business Mailing Address
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Address Line | 660 S 21ST ST
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City | IRVINGTON
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State | NJ
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Zip | 07111-4109
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Country | US
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Telephone | 973-372-4433
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Fax | 973-372-4411
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. ROY HARGROVE JR.
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Credential | MHS
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Telephone | 973-372-4433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 12345-01-04
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License Number State | NJ
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