Organization
LADACIN NETWORK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICIA CARLESIMO (EXECUTIVE DIRECTOR)
(732) 493-5900
Entity
Organization
Contact information
Practice address
755 CEDARBRIDGE AVE UNIT 8, LAKEWOOD, NJ 08701-4935
(732) 493-5900
(732) 493-5980
Mailing address
1703 KNEELEY BLVD, OCEAN, NJ 07712-7622
(732) 493-5900
(732) 493-5900
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1629458146
—
NJ
Enumeration date
12/04/2020
Last updated
12/04/2020
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