Provider Demographics
NPI:1073212981
Name:NEW JERSEY ASSOCIATION FOR COMMUNITY INTEGRATION
Entity Type:Organization
Organization Name:NEW JERSEY ASSOCIATION FOR COMMUNITY INTEGRATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-268-6000
Mailing Address - Street 1:31 SWAN LN
Mailing Address - Street 2:
Mailing Address - City:LAKE HOPATCONG
Mailing Address - State:NJ
Mailing Address - Zip Code:07849-2448
Mailing Address - Country:US
Mailing Address - Phone:862-268-6000
Mailing Address - Fax:
Practice Address - Street 1:31 SWAN LN
Practice Address - Street 2:
Practice Address - City:LAKE HOPATCONG
Practice Address - State:NJ
Practice Address - Zip Code:07849-2448
Practice Address - Country:US
Practice Address - Phone:862-268-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-28
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health