Provider Demographics
NPI:1699130633
Name:CATHOLIC CHARITIES DIOCESE OF TRENTON
Entity type:Organization
Organization Name:CATHOLIC CHARITIES DIOCESE OF TRENTON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE EXECUTIVE DIR OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:BONTCUE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:609-394-5181
Mailing Address - Street 1:383 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-5705
Mailing Address - Country:US
Mailing Address - Phone:609-394-3202
Mailing Address - Fax:
Practice Address - Street 1:88 SCHOOLHOUSE RD
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:NJ
Practice Address - Zip Code:08759-3051
Practice Address - Country:US
Practice Address - Phone:609-394-3202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ500228504OtherDHS LICENSE