Healthcare Provider Details

I. General information

NPI: 1841075199
Provider Name (Legal Business Name): WALLYNZAVY'S AUTISTIC KIDS CAN DO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2023
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 PARK AVE STE 202
PLAINFIELD NJ
07060-3024
US

IV. Provider business mailing address

62 DEKALB AVE
PLAINFIELD NJ
07063-1020
US

V. Phone/Fax

Practice location:
  • Phone: 908-753-7333
  • Fax: 908-757-0581
Mailing address:
  • Phone: 908-753-7333
  • Fax: 908-757-0581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. TALEANA WILLIAMS-HURST
Title or Position: PRESIDENT/CEO
Credential:
Phone: 908-753-7333