NPIMap

Organization Active NPI

My Father'S House, Inc

  • Addiction (Substance Use Disorder) Counselor
  • Gloucester City, NJ
National Provider Identifier
1003327388
Registry record updated Oct 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
Legal business name
MY FATHER'S HOUSE, INC
Practice address
PO Box 230
Gloucester City, NJ 08030-0230
Phone
(856) 742-0900
Fax
(856) 742-0900
NPI assigned
Oct 13, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sean Broderick
Title
Chief Operating Officer
Phone
(856) 742-0900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X Primary

Addresses

Primary practice location

PO Box 230
Gloucester City, NJ 08030-0230

Mailing address

PO Box 230
Gloucester City, NJ 08030-0230
Phone (856) 742-0900

Other identifiers 1

IdentifierTypeStateIssuer
7601905MedicaidNJ

National Provider Directory

National Provider Directory
Tax ID family
My Father'S House Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1507852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1507852800000",
    "number": "1003327388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 230",
            "city": "GLOUCESTER CITY",
            "state": "NJ",
            "postal_code": "080300230",
            "telephone_number": "856-742-0900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PO BOX 230",
            "city": "GLOUCESTER CITY",
            "state": "NJ",
            "postal_code": "080300230",
            "telephone_number": "856-742-0900",
            "fax_number": "856-742-0900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MY FATHER'S HOUSE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-13",
        "last_updated": "2017-10-13",
        "status": "A",
        "authorized_official_last_name": "BRODERICK",
        "authorized_official_first_name": "SEAN",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "856-742-0900"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7601905",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gloucester City, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.