Organization
WEST ELM SUPPORTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JASON MATHEW CLARK (OWNER)
(856) 472-2713
Entity
Organization
Contact information
Practice address
117 W ELM AVE, MANTUA, NJ 08051-1509
(856) 472-2713
Mailing address
117 W ELM AVE, MANTUA, NJ 08051-1509
(856) 472-2713
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
09/27/2023
Last updated
09/27/2023
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