Healthcare Provider Details

I. General information

NPI: 1275977696
Provider Name (Legal Business Name): NEW BEGINNINGS AT JOEYS PLACE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2013
Last Update Date: 04/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 AUTUMN DR
TINTON FALLS NJ
07753-7454
US

IV. Provider business mailing address

5310 AUTUMN DR
TINTON FALLS NJ
07753-7454
US

V. Phone/Fax

Practice location:
  • Phone: 848-525-6649
  • Fax:
Mailing address:
  • Phone: 848-525-6649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number305R00000X
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number385H00000X
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number385HR2050X
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number385HR2060X
License Number State

VIII. Authorized Official

Name: MS. ANGELA DITARANTO
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 848-525-6649