Provider Demographics
NPI:1154668341
Name:BERGEN COUNTY YJCC
Entity Type:Organization
Organization Name:BERGEN COUNTY YJCC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SPECIAL NEEDS PROGRAMS
Authorized Official - Prefix:MS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-221-5810
Mailing Address - Street 1:605 PASCACK RD
Mailing Address - Street 2:
Mailing Address - City:TOWNSHIP OF WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07676-4325
Mailing Address - Country:US
Mailing Address - Phone:201-221-5810
Mailing Address - Fax:201-221-5823
Practice Address - Street 1:605 PASCACK RD
Practice Address - Street 2:
Practice Address - City:TOWNSHIP OF WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07676-4325
Practice Address - Country:US
Practice Address - Phone:201-221-5810
Practice Address - Fax:201-221-5823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services