Healthcare Provider Details

I. General information

NPI: 1396689113
Provider Name (Legal Business Name): LEGACY HAVEN SERVICES OF NJ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 SUNRISE RD
BERLIN NJ
08009-1563
US

IV. Provider business mailing address

1215 SUNRISE RD
BERLIN NJ
08009-1563
US

V. Phone/Fax

Practice location:
  • Phone: 267-938-1566
  • Fax:
Mailing address:
  • Phone: 609-222-3323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SHEENA ADINA ALLEYNE
Title or Position: REGISTERED NURSE
Credential: BSN
Phone: 267-938-1566