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General NPI Number Information
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NPI Number | 1679000921
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Entity Type | Organization
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Legal Business Name | JEFFERSON PARK MINISTRIES, INC
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Dates
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Enumeration Date | 05/17/2017
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Last Update Date | 05/17/2017
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Provider Practice Location Address
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Address Line | 70 WEST GRAND ST
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City | ELIZABETH
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State | NJ
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Zip | 07202
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Country | US
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Telephone | 908-469-9508
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Fax | 908-469-9509
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Provider Business Mailing Address
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Address Line | 70 WEST GRAND ST
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City | ELIZABETH
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State | NJ
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Zip | 07202
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Country | US
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Telephone | 908-469-9508
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Fax | 908-469-9509
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | WOODY K PHILIPPE
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Credential |
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Telephone | 908-469-9508
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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 | 347E00000X
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Taxonomy Name | Transportation Broker
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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 | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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