Organization
THE, WARREN COUNTY CHAPTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT ALEXANDER PRUZNICK (CEO)
(908) 689-7525
Entity
Organization
Contact information
Practice address
17 HAMPTON TER, PHILLIPSBURG, NJ 08865-2015
(908) 859-3846
(908) 859-8593
Mailing address
319 W WASHINGTON AVE, WASHINGTON, NJ 07882-2157
(908) 689-7525
(908) 689-4898
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
GH579
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1063950012
—
NJ
05
—
1073051025
—
NJ
05
—
1164954384
—
NJ
05
—
1396284097
—
NJ
05
—
1508304395
—
NJ
05
—
1710229778
—
NJ
05
—
1821538638
—
NJ
05
—
1962940742
—
NJ
05
—
1982143988
—
NJ
Enumeration date
04/27/2017
Last updated
04/27/2017
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