Provider Demographics
NPI:1982115903
Name:HENDRICKS HOUSE, INC.
Entity type:Organization
Organization Name:HENDRICKS HOUSE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT TO THE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MANNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-794-2443
Mailing Address - Street 1:542 N WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-2847
Mailing Address - Country:US
Mailing Address - Phone:856-794-2443
Mailing Address - Fax:856-794-8887
Practice Address - Street 1:411 ALOE ST
Practice Address - Street 2:
Practice Address - City:EGG HARBOR CITY
Practice Address - State:NJ
Practice Address - Zip Code:08215-3559
Practice Address - Country:US
Practice Address - Phone:856-794-2443
Practice Address - Fax:856-794-8887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1000003324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0055042Medicaid