Organization
A-1 SUPPORT COORDINATION NJ
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANITA RANDOLPH (OWNER/DIRECTOR)
(856) 701-0884
Entity
Organization
Contact information
Practice address
1504 LARCHMONT PLACE, MOUNT LAUREL, NJ 08054
(856) 701-0884
Mailing address
1504 LARCHMONT PLACE, MOUNT LAUREL, NJ 08054
(856) 701-0884
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
05/22/2019
Last updated
05/22/2019
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