Provider Demographics
NPI:1730232661
Name:DEPARTMENT OF CHILDREN AND FAMILIES
Entity type:Organization
Organization Name:DEPARTMENT OF CHILDREN AND FAMILIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFONSO
Authorized Official - Middle Name:F
Authorized Official - Last Name:NICHOLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-633-6904
Mailing Address - Street 1:PO BOX 717
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08625-0717
Mailing Address - Country:US
Mailing Address - Phone:609-292-9041
Mailing Address - Fax:609-984-9615
Practice Address - Street 1:50 E STATE ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08608-1715
Practice Address - Country:US
Practice Address - Phone:609-292-9041
Practice Address - Fax:609-984-9615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0042609Medicaid
NJ4506901Medicaid
NJ4507304Medicaid
NJ4507509Medicaid