Healthcare Provider Details

I. General information

NPI: 1447176516
Provider Name (Legal Business Name): ADULTS AND CHILDREN RESIDENTIAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5805 JEFFERSON ST APT 403
WEST NEW YORK NJ
07093-1199
US

IV. Provider business mailing address

5805 JEFFERSON ST APT 403
WEST NEW YORK NJ
07093-1199
US

V. Phone/Fax

Practice location:
  • Phone: 929-360-7613
  • Fax:
Mailing address:
  • Phone: 929-360-7613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: CINDY ANN MARION
Title or Position: MANAGER
Credential:
Phone: 929-360-7613