MEDICARE: DEVELOPMENTAL DISABILITIES ASSOCIATION OF NJ 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

General Provider Information

NPI Number	:	1912387101
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEVELOPMENTAL DISABILITIES ASSOCIATION OF NJ INC.

Provider Business Mailing Address
First Line	:	40 WOODBRIDGE AVE
Second Line	:
City	:	SEWAREN
State	:	NJ
Zip	:	07077-1351
Country	:	US
Telephone Number	:	732-636-6710
Fax Number	:	732-636-5936

Provider Business Practice Location Address
First Line	:	103 GOLD ST
Second Line	:
City	:	NORTH ARLINGTON
State	:	NJ
Zip	:	07031-5623
Country	:	US
Telephone Number	:	732-636-6710
Fax Number	:	732-636-5936

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. JAMES CASALE
Credential	:
Telephone Number	:	732-636-6710

Provider Enumeration Date	:	06/03/2015
Last Update Date	:	06/03/2015

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