MEDICARE: HEART & SOUL TREATMENT CENTER

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1932523180
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEART & SOUL TREATMENT CENTER

Provider Business Mailing Address
First Line	:	329 HALSTED ST
Second Line	:
City	:	EAST ORANGE
State	:	NJ
Zip	:	07018-2533
Country	:	US
Telephone Number	:	862-224-8398
Fax Number	:

Provider Business Practice Location Address
First Line	:	329 HALSTED ST
Second Line	:
City	:	EAST ORANGE
State	:	NJ
Zip	:	07018-2533
Country	:	US
Telephone Number	:	862-224-8398
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	FACHION PAYNE
Credential	:
Telephone Number	:	862-224-8398

Provider Enumeration Date	:	02/08/2014
Last Update Date	:	02/08/2014

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Directions to “HEART & SOUL TREATMENT CENTER ” Practice Location

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