Organization
EZ MIND FAMILY MENTAL HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAN FORD APN (PMHNP/FNP)
(609) 916-6443
Entity
Organization
Contact information
Practice address
500 MAIN ST, LANOKA HARBOR, NJ 08734-2228
(609) 916-6443
(732) 358-0829
Mailing address
500 MAIN ST, LANOKA HARBOR, NJ 08734-2228
(609) 916-6443
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1912564428
COMMERCIAL INSURANCE
NJ
05
—
1912564428
—
NJ
Enumeration date
07/03/2022
Last updated
07/03/2022
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