Healthcare Provider Details

I. General information

NPI: 1215423256
Provider Name (Legal Business Name): OUR LOVED ONES CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2018
Last Update Date: 07/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 ORCHARD PL
IRVINGTON NJ
07111-1722
US

IV. Provider business mailing address

35 ORCHARD PL
IRVINGTON NJ
07111-1722
US

V. Phone/Fax

Practice location:
  • Phone: 201-889-5600
  • Fax:
Mailing address:
  • Phone: 201-889-5600
  • 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
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE BOSIRE
Title or Position: DIRECTOR/CEO
Credential:
Phone: 201-889-5600