MEDICARE: BEACON SPECIALIZED LIVING NEW JERSEY, INC.

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	:	1659238707
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEACON SPECIALIZED LIVING NEW JERSEY, INC.

Provider Business Mailing Address
First Line	:	13 ROSZEL RD STE B110
Second Line	:
City	:	PRINCETON
State	:	NJ
Zip	:	08540-6211
Country	:	US
Telephone Number	:	609-987-5003
Fax Number	:	609-520-7979

Provider Business Practice Location Address
First Line	:	44 OAK TER
Second Line	:
City	:	HOWELL
State	:	NJ
Zip	:	07731-2716
Country	:	US
Telephone Number	:	609-987-5003
Fax Number	:	609-520-7979

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DARREN HODGDON
Credential	:
Telephone Number	:	269-427-8400

Provider Enumeration Date	:	01/08/2026
Last Update Date	:	01/08/2026

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