Organization
BONNIE BRAE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL D. RIEGER MSW (CEO)
(908) 647-4719
Entity
Organization
Contact information
Practice address
3415 VALLEY ROAD, LIBERTY CORNER, NJ 07938
(908) 647-0800
(908) 647-5021
Mailing address
PO BOX 825, LIBERTY CORNER, NJ 07938-0825
(908) 647-0800
(908) 647-5021
Taxonomy
Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
—
—
3245S0500X
Children's Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003081605
—
NJ
05
—
1235405689
—
NJ
05
—
1245689686
—
NJ
05
—
1447885520
—
NJ
05
—
1497152961
—
NJ
05
—
1508220922
—
NJ
05
—
1831522523
—
NJ
05
—
183448414
—
NJ
05
—
1912063702
—
NJ
Enumeration date
09/25/2020
Last updated
09/25/2020
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