Provider Demographics
NPI:1881565943
Name:649 GREENBRIAR DR
Entity type:Organization
Organization Name:649 GREENBRIAR DR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIENNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAUTRUCHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-625-9934
Mailing Address - Street 1:649 GREENBRIAR DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-1149
Mailing Address - Country:US
Mailing Address - Phone:856-666-4929
Mailing Address - Fax:888-218-8285
Practice Address - Street 1:649 GREENBRIAR DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08094-1149
Practice Address - Country:US
Practice Address - Phone:856-666-4929
Practice Address - Fax:888-218-8285
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMPASSION HOME CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-09-12
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Single Specialty