Healthcare Provider Details

I. General information

NPI: 1033735808
Provider Name (Legal Business Name): EDUCATIONAL CENTER FOR THE DISABLES. N J NON PROFIT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 06/17/2020
Certification Date: 06/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 UNION AVE APT B2
IRVINGTON NJ
07111-2863
US

IV. Provider business mailing address

6501 E LIVINGSTON AVE STE 5
REYNOLDSBURG OH
43068-3561
US

V. Phone/Fax

Practice location:
  • Phone: 862-588-7352
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN AWERE WEBSTER
Title or Position: OWNER
Credential: MA
Phone: 862-588-7352