Provider Demographics
NPI:1003263260
Name:REVOLUTION NEW JERSEY, INC.
Entity Type:Organization
Organization Name:REVOLUTION NEW JERSEY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HRYNOWESKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-244-4402
Mailing Address - Street 1:230 ROUTE 206
Mailing Address - Street 2:BUILDING 1, SUITE #103
Mailing Address - City:FLANDERS
Mailing Address - State:NJ
Mailing Address - Zip Code:07836-9189
Mailing Address - Country:US
Mailing Address - Phone:862-244-4402
Mailing Address - Fax:
Practice Address - Street 1:230 ROUTE 206
Practice Address - Street 2:BUILDING 1, SUITE #103
Practice Address - City:FLANDERS
Practice Address - State:NJ
Practice Address - Zip Code:07836-9189
Practice Address - Country:US
Practice Address - Phone:862-244-4402
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services