Provider Demographics
NPI:1811356934
Name:INSTITUTE FOR BEHAVIORAL HEALTH AND DEVELOPMENTAL DISABILITIES INC
Entity type:Organization
Organization Name:INSTITUTE FOR BEHAVIORAL HEALTH AND DEVELOPMENTAL DISABILITIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:K
Authorized Official - Last Name:CEASER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-604-2433
Mailing Address - Street 1:400 BROADACRES DR STE 260
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-3156
Mailing Address - Country:US
Mailing Address - Phone:888-604-2433
Mailing Address - Fax:862-930-4862
Practice Address - Street 1:1980 SPRINGFIELD AVE
Practice Address - Street 2:4L
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-3440
Practice Address - Country:US
Practice Address - Phone:888-604-2433
Practice Address - Fax:862-930-4862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-17
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0490270Medicaid