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General NPI Number Information
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NPI Number | 1861989436
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Entity Type | Organization
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Legal Business Name | WILLOWGLEN ACADEMY - NEW JERSEY. INC.
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Dates
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Enumeration Date | 04/18/2018
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Last Update Date | 04/18/2018
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Provider Practice Location Address
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Address Line | 4 CENTER STREET APT 36
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City | SUSSEX
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State | NJ
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Zip | 07461
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Country | US
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Telephone | 973-579-3700
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Fax | 973-579-1786
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Provider Business Mailing Address
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Address Line | 8 WILSON DRIVE
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City | SPARTA
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State | NJ
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Zip | 07871
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Country | US
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Telephone | 973-579-3700
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Fax | 973-579-1786
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DIONE GRANT
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Credential |
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Telephone | 973-579-3700
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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 | 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 #3
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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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