Provider Inquiry Form Provider Inquiry Form Step 1 of 2 50% FacilityAddressPhone NumberFaxTINEmailCountyAtlantic CountyBergen CountyBurlington CountyCamden CountyCape May CountyCumberland CountyEssex CountyGloucester CountyHudson CountyHunterdon CountyMercer CountyMiddlesex CountyMonmouth CountyMorris CountyOcean CountyPassaic CountySalem CountySomerset CountySussex CountyUnion CountyWarren CountyTotal number of bedsMemory unit bedsOtherOwnership InformationPlease list name(s) of those owning 5% & greater interest.Special Clinical ProgramsAwards & Certifications Additional Information/CommentsCaptcha