Provider Demographics
NPI:1316420755
Name:THE NORTH WARD CENTER, INC,
Entity type:Organization
Organization Name:THE NORTH WARD CENTER, INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:YI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-481-0415
Mailing Address - Street 1:346 MOUNT PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-2106
Mailing Address - Country:US
Mailing Address - Phone:973-481-0415
Mailing Address - Fax:
Practice Address - Street 1:346 MOUNT PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-2106
Practice Address - Country:US
Practice Address - Phone:973-481-0415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE NORTH WARD CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-12
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8642109Medicaid