Healthcare Provider Details

I. General information

NPI: 1346184884
Provider Name (Legal Business Name): PIECES RESIDENTIAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 RUTGERS AVE
JERSEY CITY NJ
07305-2934
US

IV. Provider business mailing address

63 RUTGERS AVE
JERSEY CITY NJ
07305-2934
US

V. Phone/Fax

Practice location:
  • Phone: 201-492-4380
  • Fax:
Mailing address:
  • Phone: 201-492-4380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: TYQUANNA LATIFAH EVANS
Title or Position: MEMBER
Credential:
Phone: 201-492-4380