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General NPI Number Information
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NPI Number | 1992301006
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Entity Type | Organization
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Legal Business Name | GREAT MINDS COMMUNITY CARE
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Dates
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Enumeration Date | 12/05/2020
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Last Update Date | 12/05/2020
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Provider Practice Location Address
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Address Line | 817 BORDENTOWN RD
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City | BURLINGTON
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State | NJ
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Zip | 08016-1927
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Country | US
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Telephone | 609-410-9363
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2487
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City | WILLINGBORO
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State | NJ
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Zip | 08046-6587
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Country | US
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Telephone | 609-410-9363
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATIVE ASSISTANT
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Name | TOMEKI JONES
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Credential |
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Telephone | 609-531-5003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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