Healthcare Provider Details

I. General information

NPI: 1154933208
Provider Name (Legal Business Name): TAJLEARNING RESOURCE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2020
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 MINETTA RD
SOMERSET NJ
08873-3709
US

IV. Provider business mailing address

172 MINETTA RD
SOMERSET NJ
08873-3709
US

V. Phone/Fax

Practice location:
  • Phone: 973-280-5090
  • Fax:
Mailing address:
  • Phone: 973-280-5090
  • 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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. TAHNEISHA JONES
Title or Position: DIRECTOR
Credential: MA
Phone: 973-280-5090