Provider Demographics
NPI:1023544251
Name:21 PLUS, INC
Entity Type:Organization
Organization Name:21 PLUS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:VELARDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-240-3118
Mailing Address - Street 1:252 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-7582
Mailing Address - Country:US
Mailing Address - Phone:732-240-3118
Mailing Address - Fax:732-240-3381
Practice Address - Street 1:301 TWIN OAKS DR
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-3526
Practice Address - Country:US
Practice Address - Phone:732-929-1929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-09
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0465721Medicaid