Healthcare Provider Details

I. General information

NPI: 1184493561
Provider Name (Legal Business Name): TOMS RIVER FIELD OF DREAMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2023
Last Update Date: 12/27/2023
Certification Date: 12/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 N BAY AVE
TOMS RIVER NJ
08753-3301
US

IV. Provider business mailing address

37 HARPERS FERRY RD
TOMS RIVER NJ
08753-2926
US

V. Phone/Fax

Practice location:
  • Phone: 732-998-3667
  • Fax:
Mailing address:
  • Phone: 732-998-3667
  • 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 Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTIAN KANE
Title or Position: FOUNDER
Credential:
Phone: 732-998-3667