Healthcare Provider Details

I. General information

NPI: 1992210561
Provider Name (Legal Business Name): JEWISH SERVICE FOR THE DEVELOPMENTALLY DISABLED OF METROWEST, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2017
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 WEDGEWOOD DR APT 39
VERONA NJ
07044-2161
US

IV. Provider business mailing address

310 EISENHOWER PKWY
LIVINGSTON NJ
07039-1708
US

V. Phone/Fax

Practice location:
  • Phone: 973-272-7141
  • Fax:
Mailing address:
  • Phone: 973-272-7141
  • Fax: 973-992-1509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberSA1369
License Number StateNJ

VIII. Authorized Official

Name: LINDA RAE PRESS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 973-272-7141