| East Orange Substance Abuse Treatment Program | |
|
110 South Grove Street, 3rd Floor East Orange NJ 07018 | |
| (973) 266-5200 | |
| (973) 678-6843 |
| Full Name | East Orange Substance Abuse Treatment Program |
|---|---|
| Speciality | Clinic/Center |
| Location | 110 South Grove Street, 3rd Floor, East Orange, New Jersey |
| Authorized Official Name and Position | Yvonne C. Blake (DIRECTOR) |
| Authorized Official Contact | 9732665200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| East Orange Substance Abuse Treatment Program 110 South Grove Street, 3rd Floor East Orange NJ 07018 Ph: (973) 266-5200 | East Orange Substance Abuse Treatment Program 110 South Grove Street, 3rd Floor East Orange NJ 07018 Ph: (973) 266-5200 |
| NPI Number | 1487888145 |
|---|---|
| Provider Enumeration Date | 05/11/2009 |
| Last Update Date | 01/16/2020 |
| Certification Date | 01/16/2020 |
| Medicare PECOS PAC ID | 8921430976 |
|---|---|
| Medicare Enrollment ID | O20191113003219 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487888145 | NPI | - | NPPES |
| 0400476 | Medicaid | NJ | |
| 7667108 | Medicaid | NJ |
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