Healthcare Provider Details

I. General information

NPI: 1285442806
Provider Name (Legal Business Name): NEW JERSEY GROWTH PARTNERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2024
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

476 W WALNUT RD APT 58
VINELAND NJ
08360-6354
US

IV. Provider business mailing address

476 W WALNUT RD APT 58
VINELAND NJ
08360-6354
US

V. Phone/Fax

Practice location:
  • Phone: 856-558-1669
  • Fax:
Mailing address:
  • Phone: 856-558-1669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: BARSHAY L GRAVES
Title or Position: DIRECTOR
Credential:
Phone: 856-558-1669