Basic Information
| Provider Information | |||||||||
| NPI: | 1093873556 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ATLANTICARE BEHAVIORAL HEALTH, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6550 DELILAH RD | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | EGG HARBOR TOWNSHIP | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082345102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092728580 | ||||||||
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| Practice Location | |||||||||
| Address1: | 120 S WHITE HORSE PIKE | ||||||||
| Address2: | |||||||||
| City: | HAMMONTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080371804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6095617911 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2006 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| AuthorizedOfficialLastName: | DREW | ||||||||
| AuthorizedOfficialFirstName: | JULIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6096457601 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 251S00000X | N | Agencies | Community/Behavioral Health | 251S00000X | 40005-06-04 | NJ | N | Agencies | Community/Behavioral Health | 251S00000X | 2000326 | NJ | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 0437867 | 05 | NJ | MEDICAID |