Provider Demographics
NPI:1730694688
Name:COMPREHENSIVE BEHAVIORAL HEALTHCARE, INC.
Entity type:Organization
Organization Name:COMPREHENSIVE BEHAVIORAL HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAWORSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-935-3322
Mailing Address - Street 1:25 E SALEM ST
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-7427
Mailing Address - Country:US
Mailing Address - Phone:201-646-0333
Mailing Address - Fax:201-296-6319
Practice Address - Street 1:187 KEARNY AVE
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-2437
Practice Address - Country:US
Practice Address - Phone:201-998-8882
Practice Address - Fax:201-296-6319
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMPREHENSIVE BEHAVIORAL HEALTHCARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-13
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8369101Medicaid