Healthcare Provider Details

I. General information

NPI: 1124587456
Provider Name (Legal Business Name): LIVING IN HOPE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2019
Last Update Date: 03/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1481 OSAGE RD
NORTH BRUNSWICK NJ
08902-1517
US

IV. Provider business mailing address

1481 OSAGE RD
NORTH BRUNSWICK NJ
08902-1517
US

V. Phone/Fax

Practice location:
  • Phone: 617-899-1338
  • Fax:
Mailing address:
  • Phone: 617-899-1338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: SUSANNA A A
Title or Position: OWNER
Credential:
Phone: 617-899-1338