Provider Demographics
NPI:1730890633
Name:HEALING GARDEN PSYCHIATRIC SERVICES PLLC
Entity type:Organization
Organization Name:HEALING GARDEN PSYCHIATRIC SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLOLADE
Authorized Official - Middle Name:
Authorized Official - Last Name:EKWERE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN- PMHNP
Authorized Official - Phone:848-289-1892
Mailing Address - Street 1:653 W EDGAR RD # 1162
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-6574
Mailing Address - Country:US
Mailing Address - Phone:848-289-1892
Mailing Address - Fax:
Practice Address - Street 1:653 W EDGAR RD # 1162
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-6574
Practice Address - Country:US
Practice Address - Phone:848-289-1892
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1871929885OtherNPI INDIVIDUAL