Organization
BONNIE BRAE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MEGAN JILL MACDONALD (ACCOUNTANT)
(908) 542-2736
Entity
Organization
Contact information
Practice address
3415 VALLEY ROAD, BAKING RIDGE, NJ 07920-2655
(908) 647-0800
(908) 647-5021
Mailing address
PO BOX 825, LIBERTY CORNER, NJ 07938-0825
(908) 647-0800
(908) 647-5021
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
1060
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8372403
—
NJ
Enumeration date
06/07/2016
Last updated
06/07/2016
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