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NPI Code Detail

MEDICARE: OFFERING GRAIN HOLDINGS

MEDICARE: OFFERING GRAIN HOLDINGS
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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1386276780
Entity Type Code : Organization
Provider Name (Legal Business Name) : OFFERING GRAIN HOLDINGS
Provider Business Mailing Address
First Line : 504 ISLAND LN
Second Line :
City : EGG HARBOR TOWNSHIP
State : NJ
Zip : 08234-6994
Country : US
Telephone Number : 609-287-0968
Fax Number : 609-927-2796
Provider Business Practice Location Address
First Line : 2235 OCEAN HEIGHTS AVE
Second Line :
City : EGG HARBOR TOWNSHIP
State : NJ
Zip : 08234-5933
Country : US
Telephone Number : 609-287-0968
Fax Number : 609-927-2796
Authorized Official
Title or Position : THERAPIST
Name : MRS. EMILY BRAITHWAITE
Credential : LCSW
Telephone Number : 609-287-0968
Provider Enumeration Date : 02/04/2020
Last Update Date : 12/15/2020

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