Healthcare Provider Details

I. General information

NPI: 1386022747
Provider Name (Legal Business Name): SEVEN HILLS NEW JERSEY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2015
Last Update Date: 05/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 BEAR TAVERN RD
EWING NJ
08628-1021
US

IV. Provider business mailing address

81 HOPE AVE
WORCESTER MA
01603-2212
US

V. Phone/Fax

Practice location:
  • Phone: 508-755-2340
  • Fax:
Mailing address:
  • Phone: 508-755-2340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID A. JORDAN
Title or Position: PRESIDENT AND CEO
Credential: DHA, MPA
Phone: 508-755-2340