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General NPI Number Information
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NPI Number | 1922467927
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Entity Type | Organization
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Legal Business Name | JDK SOCIAL STATION, LLC
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Dates
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Enumeration Date | 02/18/2016
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Last Update Date | 02/18/2016
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Provider Practice Location Address
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Address Line | 760 POST PL
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City | SECAUCUS
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State | NJ
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Zip | 07094-3241
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Country | US
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Telephone | 201-739-8079
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Fax |
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Provider Business Mailing Address
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Address Line | 36 OAK ST
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City | HILLSDALE
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State | NJ
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Zip | 07642-2622
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Country | US
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Telephone | 201-739-8079
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Fax |
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Authorized Official
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Title or Position | CO OWNER
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Name | KIRSTEN RAFFEL
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Credential |
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Telephone | 201-739-8079
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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