Healthcare Provider Details

I. General information

NPI: 1154284362
Provider Name (Legal Business Name): DEPARTMENT OF SPECIAL EDUCATION OF THE ROMAN CATHOLIC DIOCESE OF PATER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 MOSTYN RD
RANDOLPH NJ
07869-1035
US

IV. Provider business mailing address

18 MOSTYN RD
RANDOLPH NJ
07869-1035
US

V. Phone/Fax

Practice location:
  • Phone: 201-303-6341
  • Fax:
Mailing address:
  • Phone: 201-303-6341
  • Fax:

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: SCOTT MILLIKEN
Title or Position: CEO
Credential:
Phone: 973-406-1105