Healthcare Provider Details

I. General information

NPI: 1669399564
Provider Name (Legal Business Name): MIND AND ABILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S BURNET ST
EAST ORANGE NJ
07018
US

IV. Provider business mailing address

506 W MOUNT PLEASANT AVE # 1085
LIVINGSTON NJ
07039-1701
US

V. Phone/Fax

Practice location:
  • Phone: 855-615-0777
  • Fax: 855-686-6847
Mailing address:
  • Phone: 855-615-0777
  • Fax: 855-686-6847

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

VIII. Authorized Official

Name: TIANNA WELCH
Title or Position: CEO
Credential:
Phone: 516-603-0470