Provider Demographics
NPI:1174297790
Name:JEWISH SERVICE FOR THE DEVELOPMENTALLY DISABLED OF METROWEST, INC.
Entity Type:Organization
Organization Name:JEWISH SERVICE FOR THE DEVELOPMENTALLY DISABLED OF METROWEST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:PRESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-272-7141
Mailing Address - Street 1:310 EISENHOWER PKWY
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-1708
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8 WOODLAND RD
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-1227
Practice Address - Country:US
Practice Address - Phone:973-272-7141
Practice Address - Fax:973-325-2980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1932402906Medicaid