MEDICARE: OPTIONS IMAGINED A NJ NONPROFIT CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649889668
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIONS IMAGINED A NJ NONPROFIT CORPORATION

Provider Business Mailing Address
First Line	:	677 US HIGHWAY 46 STE B
Second Line	:
City	:	KENVIL
State	:	NJ
Zip	:	07847-2699
Country	:	US
Telephone Number	:	973-583-7490
Fax Number	:

Provider Business Practice Location Address
First Line	:	2467 STATE ROUTE 10 BLDG 18-1A
Second Line	:
City	:	MORRIS PLAINS
State	:	NJ
Zip	:	07950-1318
Country	:	US
Telephone Number	:	973-583-7490
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOSEPH DESIMONE
Credential	:
Telephone Number	:	973-583-7490

Provider Enumeration Date	:	07/27/2020
Last Update Date	:	07/27/2020

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