Healthcare Provider Details

I. General information

NPI: 1043820400
Provider Name (Legal Business Name): WORLD WHEAT FOUNDATION , INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2020
Last Update Date: 08/04/2020
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 LEGREGNI STREET
SADDLE BROOK NJ
07663-6025
US

IV. Provider business mailing address

30 LEGREGNI STREET
SADDLE BROOK NJ
07663-6025
US

V. Phone/Fax

Practice location:
  • Phone: 201-530-0344
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: WON HO KANG
Title or Position: PRESIDENT
Credential:
Phone: 201-530-0344