Provider Demographics
NPI:1104335488
Name:UNITY PLACE OF MONMOUTH COUNTY, LLC
Entity type:Organization
Organization Name:UNITY PLACE OF MONMOUTH COUNTY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER - OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:TISCHLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-364-4466
Mailing Address - Street 1:1075 STEPHENSON AVE UNIT C
Mailing Address - Street 2:
Mailing Address - City:OCEANPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:07757-1242
Mailing Address - Country:US
Mailing Address - Phone:848-208-2636
Mailing Address - Fax:848-208-2051
Practice Address - Street 1:1075 STEPHENSON AVE UNIT C
Practice Address - Street 2:
Practice Address - City:OCEANPORT
Practice Address - State:NJ
Practice Address - Zip Code:07757-1242
Practice Address - Country:US
Practice Address - Phone:848-208-2636
Practice Address - Fax:848-208-2051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-29
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0497231Medicaid