Healthcare Provider Details

I. General information

NPI: 1831221951
Provider Name (Legal Business Name): VOLUNTEERS OF AMERICA-GNY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 03/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 RIFLE CAMP RD
WEST PATERSON NJ
07424-3363
US

IV. Provider business mailing address

205 W MILTON AVE
RAHWAY NJ
07065-3203
US

V. Phone/Fax

Practice location:
  • Phone: 732-827-2474
  • Fax:
Mailing address:
  • Phone: 732-827-2474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number3320
License Number StateNJ

VIII. Authorized Official

Name: MR. ROBERT EDES
Title or Position: BUSINESS MANAGER
Credential:
Phone: 732-827-2474