Provider Demographics
NPI:1447908918
Name:IGNITE ONE
Entity type:Organization
Organization Name:IGNITE ONE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:FADJA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERT-CARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-484-9818
Mailing Address - Street 1:12 BELLEVIEW CT APT D
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-4414
Mailing Address - Country:US
Mailing Address - Phone:505-484-9818
Mailing Address - Fax:
Practice Address - Street 1:12 BELLEVIEW CT APT D
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-4414
Practice Address - Country:US
Practice Address - Phone:833-404-0202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health