MEDICARE: ST REMI LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1689240483
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST REMI LLC

Provider Business Mailing Address
First Line	:	750 ROUTE 73 S STE 105A
Second Line	:
City	:	MARLTON
State	:	NJ
Zip	:	08053-4142
Country	:	US
Telephone Number	:	856-282-5566
Fax Number	:	856-396-9917

Provider Business Practice Location Address
First Line	:	750 ROUTE 73 S STE 105A
Second Line	:
City	:	MARLTON
State	:	NJ
Zip	:	08053-4142
Country	:	US
Telephone Number	:	856-282-5566
Fax Number	:	856-396-9917

Authorized Official
Title or Position	:	PRESIDENT/ MEDICAL DIRECTOR
Name	:	ISIAKA A BOLARINWA
Credential	:	MD
Telephone Number	:	856-282-5566

Provider Enumeration Date	:	06/02/2021
Last Update Date	:	05/25/2023

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Directions to “ST REMI LLC ” Practice Location

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