Basic Information
| Provider Information | |||||||||
| NPI: | 1174739858 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HIGH POINT PARTIAL CARE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 643 CROSS ST | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087014610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327309280 | ||||||||
| FaxNumber: | 7327309278 | ||||||||
| Practice Location | |||||||||
| Address1: | 162 BROAD ST | ||||||||
| Address2: | |||||||||
| City: | FLEMINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088221603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9087885979 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | STEFANSKY | ||||||||
| AuthorizedOfficialFirstName: | AARON | ||||||||
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| AuthorizedOfficialTitleorPosition: | CONTROLLER | ||||||||
| AuthorizedOfficialTelephone: | 7327309280 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | NJ | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | 7361301 | 05 | NJ | MEDICAID |