=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831221951
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VOLUNTEERS OF AMERICA-GNY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2007
-----------------------------------------------------
Last Update Date | 03/06/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 279 RIFLE CAMP RD
-----------------------------------------------------
City | WEST PATERSON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07424-3363
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-827-2474
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 205 W MILTON AVE
-----------------------------------------------------
City | RAHWAY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07065-3203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-827-2474
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS MANAGER
-----------------------------------------------------
Name | MR. ROBERT EDES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 732-827-2474
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320800000X
-----------------------------------------------------
Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
-----------------------------------------------------
License Number | 3320
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------