Healthcare Provider Details

I. General information

NPI: 1366090581
Provider Name (Legal Business Name): METRO EAST COMMUNITY CARE, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2019
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 MAIN ST STE 206B
WEST ORANGE NJ
07052-5333
US

IV. Provider business mailing address

59 MAIN ST STE 206B
WEST ORANGE NJ
07052-5333
US

V. Phone/Fax

Practice location:
  • Phone: 609-837-3147
  • Fax: 973-273-4333
Mailing address:
  • Phone: 609-837-3147
  • Fax: 973-273-4333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. DARRELL PETER SHOULARS
Title or Position: EXECUTIVE DIRECTOR/CEO
Credential: M.A., M.A.
Phone: 609-837-3147