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NPI Code Detail

MEDICARE: FOUR DIRECTIONS WELLNESS INC.

MEDICARE: FOUR DIRECTIONS WELLNESS INC.
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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
23245S0500XChildren's Substance Abuse Rehabilitation Facility
3261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number : 1184448441
Entity Type Code : Organization
Provider Name (Legal Business Name) : FOUR DIRECTIONS WELLNESS INC.
Provider Business Mailing Address
First Line : PO BOX 493
Second Line :
City : POMPTON LAKES
State : NJ
Zip : 07442-0493
Country : US
Telephone Number : 973-858-8163
Fax Number : 862-666-1074
Provider Business Practice Location Address
First Line : 400 RAMAPO AVE
Second Line :
City : POMPTON LAKES
State : NJ
Zip : 07442-1825
Country : US
Telephone Number : 973-858-8163
Fax Number : 862-666-1074
Authorized Official
Title or Position : CHAIRMAN
Name : KARL ROMAN
Credential : LCSW
Telephone Number : 973-858-8163
Provider Enumeration Date : 11/13/2024
Last Update Date : 11/13/2024

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