Provider Demographics
NPI:1326875774
Name:PREMIER HARMONY PLACE LLC
Entity type:Organization
Organization Name:PREMIER HARMONY PLACE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OKSANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BORODYNKINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-742-0349
Mailing Address - Street 1:84 LONE STAR LN
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-3878
Mailing Address - Country:US
Mailing Address - Phone:732-742-0349
Mailing Address - Fax:
Practice Address - Street 1:10 MOUNTAIN BLVD STE C
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-2639
Practice Address - Country:US
Practice Address - Phone:732-742-0349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-18
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)