Healthcare Provider Details

I. General information

NPI: 1255922563
Provider Name (Legal Business Name): LENNON'S HOUSE A NJ NONPROFIT CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2021
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 PINE ST
ROCKAWAY NJ
07866-3130
US

IV. Provider business mailing address

17 OAK LN
NEWFOUNDLAND NJ
07435-1200
US

V. Phone/Fax

Practice location:
  • Phone: 973-453-6550
  • Fax:
Mailing address:
  • Phone: 973-814-2657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER BREWSTER PHILLIPS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 973-814-2657