Basic Information
| Provider Information | |||||||||
| NPI: | 1467018127 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BANCROFT NEUROHEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1255 CALDWELL RD | ||||||||
| Address2: | |||||||||
| City: | CHERRY HILL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080343220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563481137 | ||||||||
| FaxNumber: | 8563758358 | ||||||||
| Practice Location | |||||||||
| Address1: | 42 WOODSTOWN RD | ||||||||
| Address2: | |||||||||
| City: | MULLICA HILL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080629636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007745516 | ||||||||
| FaxNumber: | 8753758358 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2019 | ||||||||
| LastUpdateDate: | 05/17/2019 | ||||||||
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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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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320900000X | Y | Residential Treatment Facilities | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
No ID Information.