Healthcare Provider Details

I. General information

NPI: 1144996018
Provider Name (Legal Business Name): THE JAN GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2021
Last Update Date: 08/19/2021
Certification Date: 07/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 DOROTHY DR
SEWELL NJ
08080
US

IV. Provider business mailing address

1239 N HOWARD ST
PHILADELPHIA PA
19122-4612
US

V. Phone/Fax

Practice location:
  • Phone: 267-230-2119
  • Fax:
Mailing address:
  • Phone: 267-230-2119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: GABRIEL CROWLEY
Title or Position: OWNER
Credential:
Phone: 267-575-6072