Healthcare Provider Details

I. General information

NPI: 1063840544
Provider Name (Legal Business Name): CLIFTON ADULT OPPORTUNITY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2013
Last Update Date: 10/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 CLIFTON AVE
CLIFTON NJ
07013-2708
US

IV. Provider business mailing address

900 CLIFTON AVE
CLIFTON NJ
07013-2708
US

V. Phone/Fax

Practice location:
  • Phone: 973-777-7114
  • Fax: 973-473-6118
Mailing address:
  • Phone: 973-777-7114
  • Fax: 973-473-6118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. GRACE E. LISBONA
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 973-777-7114