Basic Information
| Provider Information | |||||||||
| NPI: | 1154892826 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OAKS INTEGRATED CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 770 WOODLANE RD | ||||||||
| Address2: | |||||||||
| City: | WESTAMPTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080603804 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 343 S ROUTE 73 | ||||||||
| Address2: | |||||||||
| City: | HAMMONTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080372400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092675928 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2018 | ||||||||
| LastUpdateDate: | 12/06/2018 | ||||||||
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| AuthorizedOfficialLastName: | SLEEPER | ||||||||
| AuthorizedOfficialFirstName: | JOAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | AR MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6092675928 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0855X | Y | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health |
ID Information
| ID | Type | State | Issuer | Description | PENDING | 05 | NJ | MEDICAID |