Healthcare Provider Details

I. General information

NPI: 1053895672
Provider Name (Legal Business Name): SPECIAL HOMES OF NEW JERSEY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 09/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 S MAPLE AVE
BASKING RIDGE NJ
07920-1280
US

IV. Provider business mailing address

92 BROADWAY
DENVILLE NJ
07834-2761
US

V. Phone/Fax

Practice location:
  • Phone: 908-221-0801
  • Fax:
Mailing address:
  • Phone: 973-664-1770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: TERRENCE MCKEON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 973-886-1953