Provider Demographics
NPI:1447630520
Name:COMMUNITY QUEST CEDAR BRIDGE
Entity type:Organization
Organization Name:COMMUNITY QUEST CEDAR BRIDGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-646-0388
Mailing Address - Street 1:6814 TILTON RD
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-4490
Mailing Address - Country:US
Mailing Address - Phone:609-646-0388
Mailing Address - Fax:609-646-5622
Practice Address - Street 1:2026 CEDARBRIDGE RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1702
Practice Address - Country:US
Practice Address - Phone:609-646-0388
Practice Address - Fax:609-646-5622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities