Basic Information
| Provider Information | |||||||||
| NPI: | 1558793182 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHILDREN'S SPECIALIZED HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 150 NEW PROVIDENCE RD | ||||||||
| Address2: | |||||||||
| City: | MOUNTAINSIDE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070922590 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 150 NEW PROVIDENCE RD | ||||||||
| Address2: | |||||||||
| City: | MOUNTAINSIDE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070922590 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9082333720 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2013 | ||||||||
| LastUpdateDate: | 08/06/2013 | ||||||||
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| AuthorizedOfficialLastName: | LAUBE | ||||||||
| AuthorizedOfficialFirstName: | MEGHAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | SPEECH LANGAUAGE PATHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 9082333720 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320600000X | 41YS00662000 | NJ | Y | Residential Treatment Facilities | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
No ID Information.