| NPI | 1235895525 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN KIRK Gm 201-249-1621 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3104A0625X Assisted Living Facility Assisted Living, Mental Illness |
| Additional Taxonomies | 305R00000X Preferred Provider Organization |
| 3104A0630X Assisted Living Facility Assisted Living, Behavioral Disturbances | |
| 310500000X Intermediate Care Facility, Mental Illness | |
| 311ZA0620X Custodial Care Facility Adult Care Home | |
| 315P00000X Intermediate Care Facility, Mentally Retarded | |
| 320600000X Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | |
| 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | |
| 372500000X Chore Provider | |
| 3747A0650X Technician Attendant Care Provider | |
| Enumeration Date | 2021-11-11 |
| Last Update Date | 2021-11-12 |