| Power House Psychotherapy & Addiction, Llc | |
|
654 Mount Prospect Ave Ste 201 Newark NJ 07104-3110 | |
| (973) 878-3900 | |
| (973) 878-3809 |
| Full Name | Power House Psychotherapy & Addiction, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 654 Mount Prospect Ave Ste 201, Newark, New Jersey |
| Authorized Official Name and Position | Temitope Shakirat Coates (ADMINISTRATOR/EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 9738783900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Power House Psychotherapy & Addiction, Llc 654 Mount Prospect Ave Ste 201 Newark NJ 07104-3110 Ph: (973) 878-3900 | Power House Psychotherapy & Addiction, Llc 654 Mount Prospect Ave Ste 201 Newark NJ 07104-3110 Ph: (973) 878-3900 |
| NPI Number | 1649732835 |
|---|---|
| Provider Enumeration Date | 04/05/2019 |
| Last Update Date | 07/21/2019 |
| Medicare PECOS PAC ID | 3971831421 |
|---|---|
| Medicare Enrollment ID | O20190822001182 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649732835 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Francis M Bongah |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942434188 PECOS PAC ID: 8729124672 Enrollment ID: I20091006000560 |
| Provider Name | David Alabi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942645544 PECOS PAC ID: 7719128271 Enrollment ID: I20130920000551 |
| Provider Name | Temitope Shakirat Coates |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679939656 PECOS PAC ID: 6709175334 Enrollment ID: I20190311000013 |
Power House Psychotherapy & Addiction, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 654 Mount Prospect Ave Ste 201, Newark, NJ 07104 Phone: 862-888-8146 | |
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