Healthcare Provider Details

I. General information

NPI: 1568847853
Provider Name (Legal Business Name): EDEN AUTISM SERVICES.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2015
Last Update Date: 07/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 MAPLESTREAM ROAD
EAST WINDSOR NJ
08520
US

IV. Provider business mailing address

2 MERWICK ROAD
PRINCETON NJ
08540
US

V. Phone/Fax

Practice location:
  • Phone: 609-488-1940
  • Fax:
Mailing address:
  • Phone: 609-987-0099
  • Fax:

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: JAMIE K. DOUGLAS.
Title or Position: MANAGING DIRECTOR ADULT SERVICES
Credential:
Phone: 609-987-0099