Provider Demographics
NPI:1093822264
Name:DAYTOP VILLAGE OF NJ
Entity Type:Organization
Organization Name:DAYTOP VILLAGE OF NJ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE & CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCRAPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-260-9460
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:MENDHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07945-1230
Mailing Address - Country:US
Mailing Address - Phone:862-260-9460
Mailing Address - Fax:862-260-9461
Practice Address - Street 1:80 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MENDHAM
Practice Address - State:NJ
Practice Address - Zip Code:07945-1230
Practice Address - Country:US
Practice Address - Phone:973-543-5656
Practice Address - Fax:973-543-5273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJAS00023245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
348902OtherVALUE OPTIONS
NJ0438529Medicaid
NJ5161304Medicaid