Organization
BONNIE BRAE
Active
Other names
Bonnie Brae Residential Treatment Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM M. POWERS (CEO)
(908) 647-0800
Entity
Organization
Contact information
Practice address
3415 VALLEY ROAD, LIBERTY CORNER, NJ 07938
(908) 647-0800
(908) 647-5021
Mailing address
3415 VALLEY ROAD, PO BOX 825, LIBERTY CORNER, NJ 07938
(908) 647-0800
(908) 647-5021
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0032506
—
NJ
05
—
0073661
—
NJ
05
—
8372403
—
NJ
Enumeration date
12/28/2006
Last updated
07/21/2022
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