Organization
NJ MENTOR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRETT IAN COHEN (COO)
(800) 388-5150
Entity
Organization
Contact information
Practice address
13 NORTHAMPTON DR, WILLINGBORO, NJ 08046-1324
(732) 627-9890
Mailing address
80 COTTONTAIL LN STE 330, SOMERSET, NJ 08873-1100
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
01/19/2018
Last updated
03/12/2023
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