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NPI Code Detail

MEDICARE: SPECIAL HOMES OF NEW JERSEY

MEDICARE: SPECIAL HOMES OF NEW JERSEY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1320600000XIntellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number : 1740731652
Entity Type Code : Organization
Provider Name (Legal Business Name) : SPECIAL HOMES OF NEW JERSEY
Provider Business Mailing Address
First Line : 74 VILLAGE GRN STE 8
Second Line :
City : BUDD LAKE
State : NJ
Zip : 07828-1379
Country : US
Telephone Number : 973-886-1953
Fax Number : 973-664-1795
Provider Business Practice Location Address
First Line : 74 VILLAGE GRN STE 8
Second Line :
City : BUDD LAKE
State : NJ
Zip : 07828-1379
Country : US
Telephone Number : 973-886-1953
Fax Number : 973-664-1795
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : TERRENCE MCKEON
Credential : M.ED.
Telephone Number : 973-886-1953
Provider Enumeration Date : 10/17/2016
Last Update Date : 10/17/2016

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Practice Location Address:
74 VILLAGE GRN APT 10D
BUDD LAKE, NJ
07828-1379
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1659822559 — SPECIAL HOMES OF NEW JERSEY
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1013434133 — SPECIAL HOMES OF NEW JERSEY, INC.
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Directions to “SPECIAL HOMES OF NEW JERSEY ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.