Provider Demographics
NPI:1164566410
Name:THE BAPTIST HOME SOCIETY OF NJ
Entity Type:Organization
Organization Name:THE BAPTIST HOME SOCIETY OF NJ
Other - Org Name:THE CLIFFS AT EAGLE ROCK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:JR
Authorized Official - Credentials:ESQ
Authorized Official - Phone:973-669-0011
Mailing Address - Street 1:707 EAGLE ROCK AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-2180
Mailing Address - Country:US
Mailing Address - Phone:973-669-0011
Mailing Address - Fax:
Practice Address - Street 1:707 EAGLE ROCK AVE
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-2180
Practice Address - Country:US
Practice Address - Phone:973-669-0011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ30A008305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0067431Medicaid