MEDICARE: MT. CARMEL GUILD -RESIDENTIAL

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	320800000X	Mental Illness Community Based Residential Treatment Facility

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	:	1578632402
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MT. CARMEL GUILD -RESIDENTIAL

Provider Business Mailing Address
First Line	:	590 N 7TH ST
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07107-2522
Country	:	US
Telephone Number	:	973-266-7992
Fax Number	:	973-596-4057

Provider Business Practice Location Address
First Line	:	2606 NEW YORK AVE
Second Line	:
City	:	UNION CITY
State	:	NJ
Zip	:	07087-4621
Country	:	US
Telephone Number	:	201-656-7201
Fax Number	:

Authorized Official
Title or Position	:	ASSOCIATE EXECUTIVE DIRECTOR
Name	:	MS. ELIZABETH MCCLENDON
Credential	:
Telephone Number	:	973-266-7992

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	01/24/2025

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