DUNGARVIN NEW JERSEY, LLC-RANCOCAS DAY PROGRAM; NPI #1174976963

Contact Information

DUNGARVIN NEW JERSEY, LLC-RANCOCAS DAY PROGRAM

1000 REV DR MARTIN LUTHER KING JR DR
WILLINGBORO, NJ 08046

Phone: 609-871-2752
Fax:
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320900000X

Indicates primary specialty

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NPI Profile & details for DUNGARVIN NEW JERSEY, LLC-RANCOCAS DAY PROGRAM

NPI # 1174976963

LBN Legal business name DUNGARVIN NEW JERSEY, LLC-RANCOCAS DAY PROGRAM

Authorized official LORI KRESS - (CEO)

Entity Organization

Organization subpart ¹ Yes

Enumeration date 07/18/2016

Last updated 04/27/2023 - About 3 years ago

Identifiers

Medicaid

0494275

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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