Provider Demographics
NPI:1528281664
Name:ANDERSON HOUSE, INC.
Entity type:Organization
Organization Name:ANDERSON HOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMSTRUP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-534-5818
Mailing Address - Street 1:PO BOX 134
Mailing Address - Street 2:
Mailing Address - City:WHITEHOUSE STATION
Mailing Address - State:NJ
Mailing Address - Zip Code:08889-0134
Mailing Address - Country:US
Mailing Address - Phone:908-534-5818
Mailing Address - Fax:908-534-8871
Practice Address - Street 1:532 COUNTY ROAD 523
Practice Address - Street 2:
Practice Address - City:WHITEHOUSE STATION
Practice Address - State:NJ
Practice Address - Zip Code:08889-4011
Practice Address - Country:US
Practice Address - Phone:908-534-5818
Practice Address - Fax:908-534-8871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1000009-04324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7603509Medicaid