MEDICARE: HUDSON MILESTONES

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1821464660
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUDSON MILESTONES

Provider Business Mailing Address
First Line	:	365-381 CLENDENNY AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07304-1168
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9000 NEWKIRK AVE
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-4449
Country	:	US
Telephone Number	:	201-434-7783
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MS. TERESA MAIETTI
Credential	:
Telephone Number	:	201-434-7783

Provider Enumeration Date	:	08/17/2015
Last Update Date	:	08/17/2015

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Directions to “HUDSON MILESTONES ” Practice Location

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