Healthcare Provider Details

I. General information

NPI: 1396605903
Provider Name (Legal Business Name): THE DOMINGO CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2025
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 19TH ST FL 2
UNION CITY NJ
07087-5440
US

IV. Provider business mailing address

209 PASSAIC AVE
BELLEVILLE NJ
07109-1960
US

V. Phone/Fax

Practice location:
  • Phone: 973-436-4704
  • Fax: 973-436-4714
Mailing address:
  • Phone: 973-436-4704
  • Fax: 973-436-4714

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 Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: MS. AMA J BAFFOE
Title or Position: EXECUTIVE DIRECTOR
Credential: RN
Phone: 973-436-4704