MEDICARE: EVERAS COMMUNITY SERVICES, 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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	GH142A	NJ

General Provider Information

NPI Number	:	1831626654
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVERAS COMMUNITY SERVICES, INC.

Provider Business Mailing Address
First Line	:	24 WORLDS FAIR DR STE K
Second Line	:
City	:	SOMERSET
State	:	NJ
Zip	:	08873-1349
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	417 MILLSTONE RD
Second Line	:
City	:	MILLSTONE TOWNSHIP
State	:	NJ
Zip	:	08510-1521
Country	:	US
Telephone Number	:	609-223-0996
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	JENNIFER RECTOR
Credential	:
Telephone Number	:	732-805-1912

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	05/11/2017

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