Organization
EBONY ISLAND SHELTER COMPANY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN HAGANS (PRESIDENT)
(856) 262-7396
Entity
Organization
Contact information
Practice address
127 EASTMONT LN, SICKLERVILLE, NJ 08081-1913
(856) 262-7396
(856) 262-8691
Mailing address
127 EASTMONT LN, SICKLERVILLE, NJ 08081-1913
(856) 262-7396
(856) 262-8691
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
V58475691600
NJ
Other
Enumeration date
07/19/2010
Last updated
07/19/2010
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