Healthcare Provider Details

I. General information

NPI: 1801229703
Provider Name (Legal Business Name): LEE'S DEVELOPMENTAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2013
Last Update Date: 03/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 MAPLEWOOD AVE
MAPLEWOOD NJ
07040-1220
US

IV. Provider business mailing address

50 W SOUTH ORANGE AVE
SOUTH ORANGE NJ
07079-1730
US

V. Phone/Fax

Practice location:
  • Phone: 973-761-5306
  • Fax: 973-378-9525
Mailing address:
  • Phone: 973-761-5306
  • Fax: 973-378-9525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number26NO09927900
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number26NO09927900
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number26NO09927900
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number26NO09927900
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number26NO09927900
License Number StateNJ

VIII. Authorized Official

Name: MRS. EDNA YOLANDA LEE
Title or Position: OWNER
Credential: RN MSN
Phone: 973-761-0230