Healthcare Provider Details

I. General information

NPI: 1720993843
Provider Name (Legal Business Name): CHOSEN GENERATION COMMUNITY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 MONTGOMERY ST
PATERSON NJ
07501-1117
US

IV. Provider business mailing address

147 MONTGOMERY ST
PATERSON NJ
07501-1117
US

V. Phone/Fax

Practice location:
  • Phone: 973-782-6726
  • Fax: 973-782-6727
Mailing address:
  • Phone: 973-782-6726
  • Fax: 973-782-6727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIE MOODY
Title or Position: CEO
Credential: PHD
Phone: 203-947-7416