MEDICARE: LADACIN NETWORK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility		NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114307436
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LADACIN NETWORK

Provider Business Mailing Address
First Line	:	1703 KNEELEY BLVD
Second Line	:
City	:	OCEAN
State	:	NJ
Zip	:	07712-7622
Country	:	US
Telephone Number	:	732-493-5900
Fax Number	:	732-493-5980

Provider Business Practice Location Address
First Line	:	31 BURNT TAVERN RD
Second Line	:
City	:	MILLSTONE TOWNSHIP
State	:	NJ
Zip	:	08510-1102
Country	:	US
Telephone Number	:	609-223-2079
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	PATRICIA CARLESIMO
Credential	:
Telephone Number	:	732-493-5900

Provider Enumeration Date	:	06/02/2015
Last Update Date	:	06/02/2015

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Directions to “LADACIN NETWORK ” Practice Location

Language	Start Address	Practice Location

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