NPIMap

Organization Active NPI

Hendricks House, Inc.

  • Substance Abuse Rehabilitation Facility
  • Vineland, NJ
National Provider Identifier
1922217322
Registry record updated Aug 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
1000007-07 Issued in NJ
Legal business name
HENDRICKS HOUSE, INC.
Practice address
542 N West Blvd
Vineland, NJ 08360-2847
Phone
(856) 794-2443
Fax
(856) 205-9277
NPI assigned
May 22, 2007
Last updated
Aug 5, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2014

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

Authorized official

Name
Mr. Audrey Carter, MSM, LCADC
Title
Executive Director
Phone
(856) 794-2443

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X 1000007-07 NJ Primary

Addresses

Primary practice location

542 N West Blvd
Vineland, NJ 08360-2847

Mailing address

542 N. West Blvd
Vineland, NJ 08360
Phone (856) 794-2443

Other identifiers 2

IdentifierTypeStateIssuer
7609507MedicaidNJ
005515MedicaidNJ

National Provider Directory

National Provider Directory
Tax ID family
Hendricks House Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

542 N West Blvd
Vineland, NJ 08360
Phone (856) 794-2443

NPI Registry JSON

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

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407196800000",
    "number": "1922217322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "542 N. WEST BLVD",
            "city": "VINELAND",
            "state": "NJ",
            "postal_code": "08360",
            "telephone_number": "856-794-2443",
            "fax_number": "856-794-8887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "542 N WEST BLVD",
            "city": "VINELAND",
            "state": "NJ",
            "postal_code": "083602847",
            "telephone_number": "856-794-2443",
            "fax_number": "856-205-9277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HENDRICKS HOUSE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-22",
        "last_updated": "2014-08-05",
        "status": "A",
        "authorized_official_last_name": "CARTER",
        "authorized_official_first_name": "AUDREY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "856-794-2443",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MSM, LCADC"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "NJ",
            "license": "1000007-07",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7609507",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005515",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vineland, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2014; 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.