| NPI | 1679072318 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA DIALFONSO Medicaid Biller 908-730-7827 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NJ GH1406) |
| Enumeration Date | 2018-02-08 |
| Last Update Date | 2018-02-08 |