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
191 MILL CREEK RD, BAYVILLE, NJ 08721-1373
(732) 269-8022
Mailing address
1703 KNEELEY BLVD, OCEAN, NJ 07712-7622
(732) 493-5900
(732) 493-5980
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053790519
—
NJ
05
—
1245619709
—
NJ
05
—
1396966438
—
NJ
05
—
1588834550
—
NJ
05
—
1700265261
—
NJ
05
—
1780063248
—
NJ
05
—
1932379906
—
NJ
Enumeration date
06/02/2015
Last updated
06/02/2015
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