Provider Demographics
NPI:1114485489
Name:JAMESBURG MANOR LLC
Entity Type:Organization
Organization Name:JAMESBURG MANOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:ISIDRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-623-3026
Mailing Address - Street 1:5 N STATE HOME RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-2940
Mailing Address - Country:US
Mailing Address - Phone:732-521-1747
Mailing Address - Fax:732-521-0603
Practice Address - Street 1:5 N STATE HOME RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NJ
Practice Address - Zip Code:08831-2940
Practice Address - Country:US
Practice Address - Phone:732-521-1747
Practice Address - Fax:732-521-0603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness