Provider Demographics
NPI:1063028629
Name:DEVELOPMENTAL DISABILITY AWARENESS WITH LOVE
Entity Type:Organization
Organization Name:DEVELOPMENTAL DISABILITY AWARENESS WITH LOVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TYQUAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-223-5197
Mailing Address - Street 1:338 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07005-1148
Mailing Address - Country:US
Mailing Address - Phone:973-588-5370
Mailing Address - Fax:
Practice Address - Street 1:334 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BOONTON
Practice Address - State:NJ
Practice Address - Zip Code:07005-1148
Practice Address - Country:US
Practice Address - Phone:973-588-5370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-18
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities