Provider Demographics
NPI:1134646250
Name:SPECIAL HOMES OF NEW JERSEY, INC.
Entity Type:Organization
Organization Name:SPECIAL HOMES OF NEW JERSEY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-886-1953
Mailing Address - Street 1:#2 HILLTOP TERRACE
Mailing Address - Street 2:
Mailing Address - City:LONG VALLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07853-3114
Mailing Address - Country:US
Mailing Address - Phone:973-886-1953
Mailing Address - Fax:
Practice Address - Street 1:#2 HILLTOP TERRACE
Practice Address - Street 2:
Practice Address - City:LONG VALLEY
Practice Address - State:NJ
Practice Address - Zip Code:07853-3114
Practice Address - Country:US
Practice Address - Phone:973-886-1953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1639500796Medicaid