Organization
VINE COMMUNITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY ROHRER (EXECUTIVE DIRECTOR)
(856) 324-0288
Entity
Organization
Contact information
Practice address
35 W MAPLE AVE, MERCHANTVILLE, NJ 08109-5141
(856) 324-0288
Mailing address
35 W MAPLE AVE, MERCHANTVILLE, NJ 08109-5141
(856) 324-0288
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
GH1827
NJ
Other
Enumeration date
10/24/2016
Last updated
10/24/2016
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