Healthcare Provider Details

I. General information

NPI: 1780508143
Provider Name (Legal Business Name): WRIGHT INDEPENDENT LIFE OPTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 PLYMOUTH AVE
MAPLEWOOD NJ
07040-2320
US

IV. Provider business mailing address

515 VALLEY ST STE 180
MAPLEWOOD NJ
07040-1389
US

V. Phone/Fax

Practice location:
  • Phone: 973-761-0800
  • Fax: 973-767-1001
Mailing address:
  • Phone: 973-761-0800
  • Fax: 973-767-1001

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: KELDRICK JERMAINE WRIGHT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 973-761-0800