Organization Name: | EASTERN CHRISTIAN CHILDREN'S RETREAT |
NPI Number: | 1164808572 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JAYNE PRESS (EXECUTIVE DIRECTOR) |
Mailing Address: | 116 Hillside Ave Midland Park |
State: | NJ US |
Postal Code: | 074321700 |
Phone Number: | 2014455530 |
Fax Number: | |
NPI Enumeration Date: | 08/07/2015 |
NPI Last Update Date: | 08/07/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320900000X |
License Number: | SA898 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
Taxonomy Specialization: | |
Taxonomy Definition: | A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |