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General NPI Number Information
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NPI Number | 1588299390
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Entity Type | Organization
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Legal Business Name | DEVELOPMENTAL DISABILITY AWARENESS WITH LOVE (DDAWL)
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Dates
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Enumeration Date | 03/12/2020
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Last Update Date | 03/12/2020
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Provider Practice Location Address
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Address Line | 2 STILES LN
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City | MONTVILLE
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State | NJ
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Zip | 07045-9424
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Country | US
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Telephone | 973-588-5370
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Fax |
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Provider Business Mailing Address
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Address Line | 112 CORNELIA ST
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City | BOONTON
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State | NJ
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Zip | 07005-1710
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Country | US
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Telephone | 973-588-5370
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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 | TYQUAN GRIFFIN
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Credential |
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Telephone | 973-588-5370
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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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