Provider Demographics
NPI:1447337134
Name:CUMBERLAND COUNTY GUIDANCE CENTER
Entity type:Organization
Organization Name:CUMBERLAND COUNTY GUIDANCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:H
Authorized Official - Middle Name:DIETER
Authorized Official - Last Name:HOVERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:856-825-6819
Mailing Address - Street 1:PO BOX 808
Mailing Address - Street 2:2038 CARMEL ROAD
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332
Mailing Address - Country:US
Mailing Address - Phone:856-825-6810
Mailing Address - Fax:856-327-4281
Practice Address - Street 1:2038 CARMEL RD
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-9754
Practice Address - Country:US
Practice Address - Phone:856-825-6810
Practice Address - Fax:856-327-4281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0083704Medicaid
NJ4549007Medicaid
NJ0036706Medicaid
NJ8819505Medicaid
NJ7945809Medicaid
NJ0036722Medicaid
NJ0083704Medicaid
NJ464700Medicare Oscar/Certification