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General NPI Number Information
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NPI Number | 1073481537
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Entity Type | Organization
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Legal Business Name | PROCLAVE LLC
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Dates
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Enumeration Date | 10/27/2025
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Last Update Date | 10/27/2025
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Provider Practice Location Address
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Address Line | 460 N MAPLE AVE
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City | EAST ORANGE
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State | NJ
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Zip | 07017-4674
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Country | US
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Telephone | 908-460-0343
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Fax |
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Provider Business Mailing Address
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Address Line | 21 CAMBRIDGE AVE
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City | DENVILLE
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State | NJ
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Zip | 07834-9600
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Country | US
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Telephone | 908-460-0343
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ELLIS ENABOSI
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Credential | MD
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Telephone | 973-280-9600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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