Provider Demographics
NPI:1215104302
Name:THE LESTER A. DRENK BEHAVIORAL HEALTH CENTER, INC.
Entity type:Organization
Organization Name:THE LESTER A. DRENK BEHAVIORAL HEALTH CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARMORSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-267-5656
Mailing Address - Street 1:1289 ROUTE 38
Mailing Address - Street 2:SUITE 203
Mailing Address - City:HAINESPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:08036-2730
Mailing Address - Country:US
Mailing Address - Phone:609-267-5656
Mailing Address - Fax:
Practice Address - Street 1:2590 NOTTINGHAM WAY
Practice Address - Street 2:
Practice Address - City:MERCERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08619-4112
Practice Address - Country:US
Practice Address - Phone:609-584-9301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE LESTER A. DRENK BEHAVIORAL HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-08
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0165336Medicaid