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Organization

MY FATHER'S HOUSE, INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
SEAN BRODERICK (CHIEF OPERATING OFFICER)
(856) 742-0900
Entity
Organization

Contact information

Practice address
PO BOX 230, GLOUCESTER CITY, NJ 08030-0230
(856) 742-0900
(856) 742-0900
Mailing address
PO BOX 230, GLOUCESTER CITY, NJ 08030-0230
(856) 742-0900

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
7601905
NJ
Enumeration date
10/13/2017
Last updated
10/13/2017
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