Organization
DEVEREUX BRIDGETON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CAROLE CIRUCCI (FINANCE DIRECTOR)
(856) 599-6429
Entity
Organization
Contact information
Practice address
198 ROADSTOWN RD, BRIDGETON, NJ 08302-5747
(856) 599-6400
(856) 599-6404
Mailing address
286 MANTUA GROVE RD, BUILDING #4, WEST DEPTFORD, NJ 08066-1738
(856) 599-6400
(856) 599-6404
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
—
0399507
—
NJ
Enumeration date
08/10/2015
Last updated
05/09/2017
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