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General NPI Number Information
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NPI Number | 1447853965
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Entity Type | Organization
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Legal Business Name | CANELAVILLE HEALTH CARE
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Dates
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Enumeration Date | 11/18/2020
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Last Update Date | 11/27/2020
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Provider Practice Location Address
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Address Line | 611 HIDDEN VILLAGE DR
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City | PERTH AMBOY
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State | NJ
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Zip | 08861-3367
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Country | US
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Telephone | 732-925-2407
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Fax |
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Provider Business Mailing Address
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Address Line | 243 BROADWAY UNIT 9188
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City | NEWARK
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State | NJ
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Zip | 07104-7408
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Country | US
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Telephone | 732-925-2407
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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 | ROLFFI CANELA
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Credential | MBA
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Telephone | 732-925-2407
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 177F00000X
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Taxonomy Name | Lodging Provider
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License Number |
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License Number State |
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