Resiliency Behavioral Health Services Llc | |
12 Chadwick Ave Newark NJ 07108-1606 | |
(973) 866-9540 | |
Not Available |
Full Name | Resiliency Behavioral Health Services Llc |
---|---|
Speciality | Nurse Practitioner |
Location | 12 Chadwick Ave, Newark, New Jersey |
Authorized Official Name and Position | Adutwumwaa Addo (OWNER) |
Authorized Official Contact | 9737062218 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Resiliency Behavioral Health Services Llc 12 Chadwick Ave Newark NJ 07108-1606 Ph: (973) 706-2218 | Resiliency Behavioral Health Services Llc 12 Chadwick Ave Newark NJ 07108-1606 Ph: (973) 866-9540 |
NPI Number | 1164203881 |
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Provider Enumeration Date | 10/09/2023 |
Last Update Date | 11/14/2023 |
Certification Date | 11/14/2023 |
Medicare PECOS PAC ID | 5597112417 |
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Medicare Enrollment ID | O20231114001131 |
Identifier | Type | State | Issuer |
---|---|---|---|
1164203881 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Primary |
Provider Name | Adutwumwaa Addo |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1033994876 PECOS PAC ID: 1850748773 Enrollment ID: I20231122000130 |
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