Basic Information
| Provider Information | |||||||||
| NPI: | 1477045557 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BANCROFT NEUROHEALTH | ||||||||
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| OtherOrganizationName: | BANCROFT NEUROHEALTH- CAMPUS TRANSITIONAL PROGRAM | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1255 CALDWELL RD | ||||||||
| Address2: | |||||||||
| City: | CHERRY HILL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080343220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563481221 | ||||||||
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| Practice Location | |||||||||
| Address1: | 311 WALTON AVE | ||||||||
| Address2: | |||||||||
| City: | MOUNT LAUREL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080549579 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8442348387 | ||||||||
| FaxNumber: | 8564291613 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2018 | ||||||||
| LastUpdateDate: | 03/19/2019 | ||||||||
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| AuthorizedOfficialLastName: | HARTMAN | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8563481181 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 322D00000X | PRF101 | NJ | Y | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children |
No ID Information.