=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447836655
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNITED CEREBRAL PALSY OF HUDSON CNTY INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2021
-----------------------------------------------------
Last Update Date | 03/31/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 721 BROADWAY
-----------------------------------------------------
City | BAYONNE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07002-4786
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-436-2200
-----------------------------------------------------
Fax | 201-436-6642
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 721 BROADWAY
-----------------------------------------------------
City | BAYONNE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07002-4786
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-436-2200
-----------------------------------------------------
Fax | 201-436-6642
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF CLINICAL OFFICER
-----------------------------------------------------
Name | MR. HAROLD REGGIE NEAL
-----------------------------------------------------
Credential | LMSW, CERT.SSW
-----------------------------------------------------
Telephone | 120-143-6220
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------