NPIMap

Organization Active NPI

Philip House Outpatient Services

  • Substance Abuse Rehabilitation Facility
  • Long Branch, NJ
National Provider Identifier
1902043052
Registry record updated Jun 27, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
200011008 Issued in NJ
Legal business name
PHILIP HOUSE OUTPATIENT SERVICES
Practice address
190 Chelsea Ave
Long Branch, NJ 07740-6712
Phone
(732) 870-8500
Fax
(732) 222-9315
NPI assigned
Jan 12, 2009
Last updated
Jun 27, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
NEW HOPE FOUNDATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 27, 2011

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

Authorized official

Name
Ms. Samantha Kuncken, LCADC
Title
Director
Phone
(732) 870-8500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X 200011008 NJ Primary

Addresses

Primary practice location

190 Chelsea Ave
Long Branch, NJ 07740-6712

Mailing address

190 Chelsea Ave
Long Branch, NJ 07740-6712
Phone (732) 870-8500

Other identifiers 2

IdentifierTypeStateIssuer
0189324MedicaidNJ
0189201MedicaidNJ

National Provider Directory

National Provider Directory
Tax ID family
New Hope Foundation Inc9 organizations share this tax ID, including this one
Part of
New Hope Foundation Inc

Other organizations with this tax ID 8

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

Locations

190 Chelsea Ave
Long Branch, NJ 07740
Phone (732) 402-7245

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1231718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309132800000",
    "number": "1902043052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 CHELSEA AVE",
            "city": "LONG BRANCH",
            "state": "NJ",
            "postal_code": "077406712",
            "telephone_number": "732-870-8500",
            "fax_number": "732-222-9315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 CHELSEA AVE",
            "city": "LONG BRANCH",
            "state": "NJ",
            "postal_code": "077406712",
            "telephone_number": "732-870-8500",
            "fax_number": "732-222-9315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHILIP HOUSE OUTPATIENT SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NEW HOPE FOUNDATION",
        "enumeration_date": "2009-01-12",
        "last_updated": "2011-06-27",
        "status": "A",
        "authorized_official_last_name": "KUNCKEN",
        "authorized_official_first_name": "SAMANTHA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "732-870-8500",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCADC"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "NJ",
            "license": "200011008",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0189324",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0189201",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Branch, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2011; 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.