Provider Demographics
NPI:1548927106
Name:SPIRITUAL AWAKENING LLC
Entity type:Organization
Organization Name:SPIRITUAL AWAKENING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DON
Authorized Official - Middle Name:M
Authorized Official - Last Name:COOLAMESTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-358-5150
Mailing Address - Street 1:251 PRINCETON HIGHTSTOWN RD STE 1
Mailing Address - Street 2:
Mailing Address - City:EAST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08520-1422
Mailing Address - Country:US
Mailing Address - Phone:856-745-1283
Mailing Address - Fax:
Practice Address - Street 1:251 PRINCETON HIGHTSTOWN RD STE 1
Practice Address - Street 2:
Practice Address - City:EAST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08520-1422
Practice Address - Country:US
Practice Address - Phone:856-745-1283
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health