Healthcare Provider Details

I. General information

NPI: 1134467988
Provider Name (Legal Business Name): JCC METROWEST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2013
Last Update Date: 06/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 NORTHFIELD AVE
WEST ORANGE NJ
07052-1102
US

IV. Provider business mailing address

760 NORTHFIELD AVE
WEST ORANGE NJ
07052-1102
US

V. Phone/Fax

Practice location:
  • Phone: 973-530-3507
  • Fax: 973-463-3942
Mailing address:
  • Phone: 973-530-3507
  • Fax: 973-463-3942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. ALAN FELDMAN
Title or Position: CEO
Credential: MSW
Phone: 973-530-3988