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General NPI Number Information
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NPI Number | 1083275804
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Entity Type | Organization
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Legal Business Name | JAYSON WILLIAMS CENTER INC.
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Dates
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Enumeration Date | 06/24/2019
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Last Update Date | 06/24/2019
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Provider Practice Location Address
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Address Line | 5499 N FEDERAL HWY STE GANDL2
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City | BOCA RATON
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State | FL
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Zip | 33487-4993
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Country | US
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Telephone | 561-767-6955
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Fax | 561-235-5649
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Provider Business Mailing Address
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Address Line | 98 WOODLAND AVE
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City | VERONA
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State | NJ
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Zip | 07044-2208
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Country | US
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Telephone | 973-819-1594
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MARIA HOOGTERP
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Credential |
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Telephone | 973-819-1594
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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