Basic Information
| Provider Information | |||||||||
| NPI: | 1396303152 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BANCROFT NEUROHEALTH | ||||||||
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| OtherOrganizationName: | BANCROFT NEUROHEALTH-P&A RESPITE | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1255 CALDWELL RD | ||||||||
| Address2: | |||||||||
| City: | CHERRY HILL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080343220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563243242 | ||||||||
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| Practice Location | |||||||||
| Address1: | 311 WALTON AVE | ||||||||
| Address2: | |||||||||
| City: | MOUNT LAUREL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080549579 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007745516 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2019 | ||||||||
| LastUpdateDate: | 06/06/2019 | ||||||||
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| AuthorizedOfficialLastName: | BURTON | ||||||||
| AuthorizedOfficialFirstName: | GINA | ||||||||
| AuthorizedOfficialMiddleName: | RENEE | ||||||||
| AuthorizedOfficialTitleorPosition: | AVP PATIENT FINANCIAL SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 8563481181 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA3000X | N | Ambulatory Health Care Facilities | Clinic/Center | Augmentative Communication | 385HR2060X | N | Respite Care Facility | Respite Care | Respite Care, Mental Retardation and/or Developmental Disabilities, Child | 385HR2055X | Y | Respite Care Facility | Respite Care | Respite Care, Mental Illness, Child |
No ID Information.