Provider Demographics
NPI:1033650411
Name:SPECIAL PARENT ADVOCACY GROUP A NJ NON PROFIT CORPORATION
Entity Type:Organization
Organization Name:SPECIAL PARENT ADVOCACY GROUP A NJ NON PROFIT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WHITFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-509-8961
Mailing Address - Street 1:1 US HIGHWAY 46 W
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07407-0220
Mailing Address - Country:US
Mailing Address - Phone:201-509-8961
Mailing Address - Fax:609-642-2398
Practice Address - Street 1:1030 OLD TRENTON RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08690-1230
Practice Address - Country:US
Practice Address - Phone:201-509-8961
Practice Address - Fax:609-642-2398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-17
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1922421593Medicaid