Organization
LAURA FONVILLE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA ANGELA FONVILLE (DIRECTOR)
(609) 594-7726
Entity
Organization
Contact information
Practice address
218 PINE AVE, EGG HARBOR TOWNSHIP, NJ 08234-5339
(609) 594-7726
Mailing address
218 PINE AVE, EGG HARBOR TOWNSHIP, NJ 08234-5339
(609) 594-7726
Taxonomy
Speciality
Code
Description
License number
State
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0500321
—
NJ
Enumeration date
04/11/2018
Last updated
04/11/2018
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