Healthcare Provider Details

I. General information

NPI: 1750376133
Provider Name (Legal Business Name): JSAS HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 NEPTUNE BLVD SUITE 101
NEPTUNE NJ
07753-4118
US

IV. Provider business mailing address

685 NEPTUNE BLVD SUITE 101
NEPTUNE NJ
07753-4118
US

V. Phone/Fax

Practice location:
  • Phone: 732-988-8877
  • Fax: 732-988-2572
Mailing address:
  • Phone: 732-988-8877
  • Fax: 732-988-2572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number41340
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DIANE VILLARI
Title or Position: DEPUTY EXECUTIVE/COO
Credential: MS
Phone: 732-988-8877