Healthcare Provider Details

I. General information

NPI: 1164802955
Provider Name (Legal Business Name): JESPY HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2015
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 S ORANGE AVE STE LL4
SOUTH ORANGE NJ
07079-1923
US

IV. Provider business mailing address

76 S ORANGE AVE STE 205
SOUTH ORANGE NJ
07079-1923
US

V. Phone/Fax

Practice location:
  • Phone: 973-762-6909
  • Fax:
Mailing address:
  • Phone: 976-762-6909
  • Fax: 973-762-5610

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

VIII. Authorized Official

Name: AUDREY WINKLER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 973-762-6909