Healthcare Provider Details

I. General information

NPI: 1144844200
Provider Name (Legal Business Name): OPEN ROADS SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2020
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 CARNEGIE AVE APT 1
EAST ORANGE NJ
07018-2927
US

IV. Provider business mailing address

108 CARNEGIE AVE APT 1
EAST ORANGE NJ
07018-2927
US

V. Phone/Fax

Practice location:
  • Phone: 973-388-4751
  • Fax: 877-744-8986
Mailing address:
  • Phone: 973-388-4751
  • Fax: 877-744-8986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: YOHANDRA C GRILLO
Title or Position: OWNER
Credential:
Phone: 973-388-4751