Provider Demographics
NPI:1861126146
Name:THE SANCTUARY VILLAGE LLC
Entity type:Organization
Organization Name:THE SANCTUARY VILLAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TYHEMA
Authorized Official - Middle Name:N
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-727-3317
Mailing Address - Street 1:127 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-2901
Mailing Address - Country:US
Mailing Address - Phone:347-727-3317
Mailing Address - Fax:
Practice Address - Street 1:127 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-2901
Practice Address - Country:US
Practice Address - Phone:347-727-3317
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management