| Kwenyan Professional Health Services, Llc | |
|
60 Evergreen Pl Suite 500 East Orange NJ 07018-2106 | |
| (973) 672-6900 | |
| (866) 376-8262 |
| Full Name | Kwenyan Professional Health Services, Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 60 Evergreen Pl, East Orange, New Jersey |
| Authorized Official Name and Position | Daniel Cassell (PRESIDENT/CEO) |
| Authorized Official Contact | 9736726900 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kwenyan Professional Health Services, Llc 60 Evergreen Pl Suite 500 East Orange NJ 07018-2106 Ph: (973) 672-6900 | Kwenyan Professional Health Services, Llc 60 Evergreen Pl Suite 500 East Orange NJ 07018-2106 Ph: (973) 672-6900 |
| NPI Number | 1326368267 |
|---|---|
| Provider Enumeration Date | 06/02/2010 |
| Last Update Date | 06/02/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326368267 | NPI | - | NPPES |
| 0227773 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 2000479-10 (New Jersey) | Primary |
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