Healthcare Provider Details

I. General information

NPI: 1932659455
Provider Name (Legal Business Name): SPECIAL HOMES OF NEW JERSEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2016
Last Update Date: 04/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 VILLAGE GRN APT 10D
BUDD LAKE NJ
07828-1379
US

IV. Provider business mailing address

74 VILLAGE GRN APT 14R
BUDD LAKE NJ
07828-1379
US

V. Phone/Fax

Practice location:
  • Phone: 973-886-1953
  • Fax: 973-664-1795
Mailing address:
  • Phone: 973-886-1953
  • Fax: 973-664-1795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
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: M.ED.
Phone: 973-886-1953