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General NPI Number Information
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NPI Number | 1053895672
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Entity Type | Organization
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Legal Business Name | SPECIAL HOMES OF NEW JERSEY, INC.
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Dates
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Enumeration Date | 09/19/2018
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Last Update Date | 09/19/2018
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Provider Practice Location Address
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Address Line | 175 S MAPLE AVE
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City | BASKING RIDGE
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State | NJ
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Zip | 07920-1280
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Country | US
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Telephone | 908-221-0801
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Fax |
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Provider Business Mailing Address
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Address Line | 92 BROADWAY
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City | DENVILLE
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State | NJ
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Zip | 07834-2761
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Country | US
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Telephone | 973-664-1770
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | TERRENCE MCKEON
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Credential |
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Telephone | 973-886-1953
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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