MEDICARE: THE LESTER A. DRENK BEHAVIORAL HEALTH CENTER, 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
1	251S00000X	Community/Behavioral Health Agency

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

General Provider Information

NPI Number	:	1306012885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE LESTER A. DRENK BEHAVIORAL HEALTH CENTER, INC.

Provider Business Mailing Address
First Line	:	1289 ROUTE 38
Second Line	:	SUITE 203
City	:	HAINESPORT
State	:	NJ
Zip	:	08036-2730
Country	:	US
Telephone Number	:	609-267-5656
Fax Number	:

Provider Business Practice Location Address
First Line	:	126 SPOUT SPRING AVE
Second Line	:
City	:	MOUNT HOLLY
State	:	NJ
Zip	:	08060-2030
Country	:	US
Telephone Number	:	609-261-3034
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. HARRY MARMORSTEIN
Credential	:
Telephone Number	:	609-267-5656

Provider Enumeration Date	:	05/05/2008
Last Update Date	:	02/27/2009

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