Active NPI
Vivion Larry Bambara
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
- Lindenwold, NJ
National Provider Identifier
1649857186
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
- Practice address
- 101 E Gibbsboro Rd Apt 1611
Lindenwold, NJ 08021-1923 - Phone
- (346) 262-7732
- NPI assigned
- Mar 29, 2021
- Last updated
- Jan 1, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmentally Disabled Services Day Training Agency | 251C00000X | NU | ||
| Adult Day Care Clinic/Center | 261QA0600X | NU | ||
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | 320900000X | NJ | Primary |
Addresses
Primary practice location
101 E Gibbsboro Rd Apt 1611
Lindenwold, NJ 08021-1923
Mailing address
101 E Gibbsboro Rd Apt 1611
Lindenwold, NJ 08021-1923
Phone (346) 262-7732
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649857186 | Medicaid | NJ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1616976000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1640995200000",
"number": "1649857186",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 E GIBBSBORO RD APT 1611",
"city": "LINDENWOLD",
"state": "NJ",
"postal_code": "080211923",
"telephone_number": "346-262-7732"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 E GIBBSBORO RD APT 1611",
"city": "LINDENWOLD",
"state": "NJ",
"postal_code": "080211923",
"telephone_number": "346-262-7732"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAMBARA",
"first_name": "VIVION",
"middle_name": "LARRY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-03-29",
"last_updated": "2022-01-01",
"certification_date": "2021-09-06",
"status": "A"
},
"taxonomies": [
{
"code": "251C00000X",
"taxonomy_group": "",
"desc": "Day Training, Developmentally Disabled Services",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "261QA0600X",
"taxonomy_group": "",
"desc": "Clinic/Center, Adult Day Care",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "320900000X",
"taxonomy_group": "",
"desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
"state": "NJ",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1649857186",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lindenwold, NJ
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- Bienestar LLC (Bienestar Pharmacy & Wellness Center)
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- Kimberly Michelle Bittner
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.