Basic Information
| Provider Information | |||||||||
| NPI: | 1073032868 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ATLANTICARE BEHAVIORAL HEALTH, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6550 DELILAH RD STE 301 | ||||||||
| Address2: | |||||||||
| City: | EGG HARBOR TOWNSHIP | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082345102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092728580 | ||||||||
| FaxNumber: | 6096457343 | ||||||||
| Practice Location | |||||||||
| Address1: | 13 N HARTFORD AVE | ||||||||
| Address2: | |||||||||
| City: | ATLANTIC CITY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 084013512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6093481161 | ||||||||
| FaxNumber: | 6096457343 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2017 | ||||||||
| LastUpdateDate: | 12/18/2017 | ||||||||
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| AuthorizedOfficialLastName: | HELMS | ||||||||
| AuthorizedOfficialFirstName: | PATRICIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR, INFORMATION MANAGEMENT | ||||||||
| AuthorizedOfficialTelephone: | 6094846417 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ATLANTICARE BEHAVIORAL HEALTH, INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 400050604 | NJ | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 0004812 | 05 | NJ | MEDICAID |