Provider Demographics
NPI:1538885173
Name:MIRTH HEALTH SYSTEMS LLC
Entity type:Organization
Organization Name:MIRTH HEALTH SYSTEMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUWABUKOLA
Authorized Official - Middle Name:PRINCESS
Authorized Official - Last Name:ADASOFUNJO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-445-3315
Mailing Address - Street 1:PO BOX 293
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08542-0293
Mailing Address - Country:US
Mailing Address - Phone:312-731-7525
Mailing Address - Fax:
Practice Address - Street 1:194 N HARRISON ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-3516
Practice Address - Country:US
Practice Address - Phone:609-445-3315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health