Provider Demographics
NPI:1134637465
Name:SPECIAL NEEDS RESIDENCE LLC
Entity Type:Organization
Organization Name:SPECIAL NEEDS RESIDENCE LLC
Other - Org Name:MT BETHEL VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-889-4200
Mailing Address - Street 1:316 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:FANWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07023-1325
Mailing Address - Country:US
Mailing Address - Phone:908-889-4200
Mailing Address - Fax:
Practice Address - Street 1:130 MOUNT BETHEL RD APT 106
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-5129
Practice Address - Country:US
Practice Address - Phone:908-757-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPECIAL NEEDS RESIDENCE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities