Healthcare Provider Details

I. General information

NPI: 1437807773
Provider Name (Legal Business Name): INTEGRITY LIVING FDN. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2022
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 N GOUVERNEUR AVE
TRENTON NJ
08618-5308
US

IV. Provider business mailing address

122 N GOUVERNEUR AVE
TRENTON NJ
08618-5308
US

V. Phone/Fax

Practice location:
  • Phone: 267-987-8844
  • Fax:
Mailing address:
  • Phone: 267-987-8844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MISS CYNTHIA ROESLER
Title or Position: FOUNDER/OWNER
Credential:
Phone: 267-987-8844