Basic Information
| Provider Information | |||||||||
| NPI: | 1285987883 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ATLANTICARE BEHAVIORAL HEALTH, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6550 DELILAH RD | ||||||||
| Address2: | |||||||||
| City: | EGG HARBOR TOWNSHIP | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082345102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092728580 | ||||||||
| FaxNumber: | 6096457343 | ||||||||
| Practice Location | |||||||||
| Address1: | 6010 BLACK HORSE PIKE | ||||||||
| Address2: | |||||||||
| City: | EGG HARBOR TOWNSHIP | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082349752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092720909 | ||||||||
| FaxNumber: | 6096457343 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2012 | ||||||||
| LastUpdateDate: | 12/18/2017 | ||||||||
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| AuthorizedOfficialLastName: | DREW | ||||||||
| AuthorizedOfficialFirstName: | JULIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6095697868 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 40005-23-04 | NJ | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 6683517 | 05 | NJ | MEDICAID |